Ditlevsen, Susanne; Samson, Adeline
Dynamics of the membrane potential in a single neuron can be studied by estimating biophysical parameters from intracellular recordings. Diffusion processes, given as continuous solutions to stochastic differential equations, are widely applied as models for the neuronal membrane potential evolut...
Mueller, Jerel K.; Grigsby, Erinn M.; Prevosto, Vincent; Petraglia, Frank W.; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V.; Sommer, Marc A.; Egner, Tobias; Platt, Michael L.; Grill, Warren M.
Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report novel methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally per...
Mueller, Jerel K; Grigsby, Erinn M; Prevosto, Vincent; Petraglia, Frank W; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V; Sommer, Marc A; Egner, Tobias; Platt, Michael L; Grill, Warren M
Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report new methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally perturbed by stimulation artifact in awake monkeys (Macaca mulatta). We recorded action potentials within ∼1 ms after 0.4-ms TMS pulses and observed changes in activity that differed significantly for active stimulation as compared with sham stimulation. This methodology is compatible with standard equipment in primate laboratories, allowing easy implementation. Application of these tools will facilitate the refinement of next generation TMS devices, experiments and treatment protocols.
Mueller, Jerel K.; Grigsby, Erinn M.; Prevosto, Vincent; Petraglia, Frank W.; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V.; Sommer, Marc A.; Egner, Tobias; Platt, Michael L.; Grill, Warren M.
Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report novel methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally perturbed by stimulation artifact in intact, awake monkeys (Macaca mulatta). We recorded action potentials within ~1 ms after 0.4 ms TMS pulses and observed changes in activity that differed significantly for active stimulation as compared to sham stimulation. The methodology is compatible with standard equipment in primate laboratories, allowing for easy implementation. Application of these new tools will facilitate the refinement of next generation TMS devices, experiments, and treatment protocols. PMID:24974797
Erika K Hussey
Full Text Available We report the results of a bilingual continuous recognition memory task during which single- and multi-neuron activity was recorded in human subjects with intracranial microwire implants. Subjects (n = 5 were right-handed Spanish-English bilinguals who were undergoing evaluation prior to surgery for severe epilepsy. Subjects were presented with Spanish and English words and the task was to determine whether any given word had been seen earlier in the testing session, irrespective of the language in which it had appeared. Recordings in the left and right hippocampus revealed notable laterality, whereby both Spanish and English items that had been seen previously in the other language (switch trials triggered increased neural firing in the left hippocampus. Items that had been seen previously in the same language (repeat trials triggered increased neural firings in the right hippocampus. These results are consistent with theories that propose roles of both the left- and right-hemisphere in real-time linguistic processing. Importantly, this experiment presents the first instance of intracranial recordings in bilinguals performing a task with switching demands.
Colvin, Robert A; Lai, Barry; Holmes, William R; Lee, Daewoo
The purpose of this study was to demonstrate how single cell quantitative and subcellular metallomics inform us about both the spatial distribution and cellular mechanisms of metal buffering and homeostasis in primary cultured neurons from embryonic rat brain, which are often used as models of human disease involving metal dyshomeostasis. The present studies utilized synchrotron radiation X-ray fluorescence (SRXRF) and focused primarily on zinc and iron, two abundant metals in neurons that have been implicated in the pathogenesis of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. Total single cell contents for calcium, iron, zinc, copper, manganese, and nickel were determined. Resting steady state zinc showed a diffuse distribution in both soma and processes, best defined by the mass profile of the neuron with an enrichment in the nucleus compared with the cytoplasm. Zinc buffering and homeostasis was studied using two modes of cellular zinc loading - transporter and ionophore (pyrithione) mediated. Single neuron zinc contents were shown to statistically significantly increase by either loading method - ionophore: 160 million to 7 billion; transporter 160 million to 280 million atoms per neuronal soma. The newly acquired and buffered zinc still showed a diffuse distribution. Soma and processes have about equal abilities to take up zinc via transporter mediated pathways. Copper levels are distributed diffusely as well, but are relatively higher in the processes relative to zinc levels. Prior studies have observed iron puncta in certain cell types, but others have not. In the present study, iron puncta were characterized in several primary neuronal types. The results show that iron puncta could be found in all neuronal types studied and can account for up to 50% of the total steady state content of iron in neuronal soma. Although other metals can be present in iron puncta, they are predominantly iron containing and do not appear to be
McKenna, Thomas M; Zornetzer, Steven F
This book contains twenty-two original contributions that provide a comprehensive overview of computational approaches to understanding a single neuron structure. The focus on cellular-level processes is twofold. From a computational neuroscience perspective, a thorough understanding of the information processing performed by single neurons leads to an understanding of circuit- and systems-level activity. From the standpoint of artificial neural networks (ANNs), a single real neuron is as complex an operational unit as an entire ANN, and formalizing the complex computations performed by real n
Fujiyama, Fumino; Nakano, Takashi; Matsuda, Wakoto; Furuta, Takahiro; Udagawa, Jun; Kaneko, Takeshi
The external globus pallidus (GP) is known as a relay nucleus of the indirect pathway of the basal ganglia. Recent studies in dopamine-depleted and healthy rats indicate that the GP comprises two main types of pallidofugal neurons: the so-called "prototypic" and "arkypallidal" neurons. However, the reconstruction of complete arkypallidal neurons in healthy rats has not been reported. Here we visualized the entire axonal arborization of four single arkypallidal neurons and six single prototypic neurons in rat brain using labeling with a viral vector expressing membrane-targeted green fluorescent protein and examined the distribution of axon boutons in the target nuclei. Results revealed that not only the arkypallidal neurons but nearly all of the prototypic neurons projected to the striatum with numerous axon varicosities. Thus, the striatum is a major target nucleus for pallidal neurons. Arkypallidal and prototypic GP neurons located in the calbindin-positive and calbindin-negative regions mainly projected to the corresponding positive and negative regions in the striatum. Because the GP and striatum calbindin staining patterns reflect the topographic organization of the striatopallidal projection, the striatal neurons in the sensorimotor and associative regions constitute the reciprocal connection with the GP neurons in the corresponding regions.
Full Text Available Recent developments of multielectrode technology made it possible to measure the extracellular potential generated in the neural tissue with spatial precision on the order of tens of micrometers and on submillisecond time scale. Combining such measurements with imaging of single neurons within the studied tissue opens up new experimental possibilities for estimating distribution of current sources along a dendritic tree. In this work we show that if we are able to relate part of the recording of extracellular potential to a specific cell of known morphology we can estimate the spatiotemporal distribution of transmembrane currents along it. We present here an extension of the kernel CSD method (Potworowski et al., 2012 applicable in such case. We test it on several model neurons of progressively complicated morphologies from ball-and-stick to realistic, up to analysis of simulated neuron activity embedded in a substantial working network (Traub et al, 2005. We discuss the caveats and possibilities of this new approach.
Hutt, Axel; Buhry, Laure
Anaesthetic agents are known to affect extra-synaptic GABAergic receptors, which induce tonic inhibitory currents. Since these receptors are very sensitive to small concentrations of agents, they are supposed to play an important role in the underlying neural mechanism of general anaesthesia. Moreover anaesthetic agents modulate the encephalographic activity (EEG) of subjects and hence show an effect on neural populations. To understand better the tonic inhibition effect in single neurons on neural populations and hence how it affects the EEG, the work considers single neurons and neural populations in a steady-state and studies numerically and analytically the modulation of their firing rate and nonlinear gain with respect to different levels of tonic inhibition. We consider populations of both type-I (Leaky Integrate-and-Fire model) and type-II (Morris-Lecar model) neurons. To bridge the single neuron description to the population description analytically, a recently proposed statistical approach is employed which allows to derive new analytical expressions for the population firing rate for type-I neurons. In addition, the work shows the derivation of a novel transfer function for type-I neurons as considered in neural mass models and studies briefly the interaction of synaptic and extra-synaptic inhibition. We reveal a strong subtractive and divisive effect of tonic inhibition in type-I neurons, i.e. a shift of the firing rate to higher excitation levels accompanied by a change of the nonlinear gain. Tonic inhibition shortens the excitation window of type-II neurons and their populations while maintaining the nonlinear gain. The gained results are interpreted in the context of recent experimental findings under propofol-induced anaesthesia.
Fu, Tian-Ming; Hong, Guosong; Zhou, Tao; Schuhmann, Thomas G; Viveros, Robert D; Lieber, Charles M
Stable in vivo mapping and modulation of the same neurons and brain circuits over extended periods is critical to both neuroscience and medicine. Current electrical implants offer single-neuron spatiotemporal resolution but are limited by such factors as relative shear motion and chronic immune responses during long-term recording. To overcome these limitations, we developed a chronic in vivo recording and stimulation platform based on flexible mesh electronics, and we demonstrated stable multiplexed local field potentials and single-unit recordings in mouse brains for at least 8 months without probe repositioning. Properties of acquired signals suggest robust tracking of the same neurons over this period. This recording and stimulation platform allowed us to evoke stable single-neuron responses to chronic electrical stimulation and to carry out longitudinal studies of brain aging in freely behaving mice. Such advantages could open up future studies in mapping and modulating changes associated with learning, aging and neurodegenerative diseases.
Zandt, B.; Stigen, Tyler; ten Haken, Bernard; Netoff, Theoden; van Putten, Michel Johannes Antonius Maria
We studied single neuron dynamics during anoxic depolarizations, which are often observed in cases of neuronal energy depletion. Anoxic and similar depolarizations play an important role in several pathologies, notably stroke, migraine, and epilepsy. One of the effects of energy depletion was
Nakamura, Hisashi; Hioki, Hiroyuki; Furuta, Takahiro; Kaneko, Takeshi
The lateral posterior thalamic nucleus (LP) is one of the components of the extrageniculate pathway in the rat visual system, and is cytoarchitecturally divided into three subdivisions--lateral (LPl), rostromedial (LPrm), and caudomedial (LPcm) portions. To clarify the differences in the dendritic fields and axonal arborisations among the three subdivisions, we applied a single-neuron labeling technique with viral vectors to LP neurons. The proximal dendrites of LPl neurons were more numerous than those of LPrm and LPcm neurons, and LPrm neurons tended to have wider dendritic fields than LPl neurons. We then analysed the axonal arborisations of LP neurons by reconstructing the axon fibers in the cortex. The LPl, LPrm and LPcm were different from one another in terms of the projection targets--the main target cortical regions of LPl and LPrm neurons were the secondary and primary visual areas, whereas those of LPcm neurons were the postrhinal and temporal association areas. Furthermore, the principal target cortical layers of LPl neurons in the visual areas were middle layers, but that of LPrm neurons was layer 1. This indicates that LPl and LPrm neurons can be categorised into the core and matrix types of thalamic neurons, respectively, in the visual areas. In addition, LPl neurons formed multiple axonal clusters within the visual areas, whereas the fibers of LPrm neurons were widely and diffusely distributed. It is therefore presumed that these two types of neurons play different roles in visual information processing by dual thalamocortical innervation of the visual areas. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.
Kuramoto, Eriko; Pan, Shixiu; Furuta, Takahiro; Tanaka, Yasuhiro R; Iwai, Haruki; Yamanaka, Atsushi; Ohno, Sachi; Kaneko, Takeshi; Goto, Tetsuya; Hioki, Hiroyuki
The prefrontal cortex has an important role in a variety of cognitive and executive processes, and is generally defined by its reciprocal connections with the mediodorsal thalamic nucleus (MD). The rat MD is mainly subdivided into three segments, the medial (MDm), central (MDc), and lateral (MDl) divisions, on the basis of the cytoarchitecture and chemoarchitecture. The MD segments are known to topographically project to multiple prefrontal areas at the population level: the MDm mainly to the prelimbic, infralimbic, and agranular insular areas; the MDc to the orbital and agranular insular areas; and the MDl to the prelimbic and anterior cingulate areas. However, it is unknown whether individual MD neurons project to single or multiple prefrontal cortical areas. In the present study, we visualized individual MD neurons with Sindbis virus vectors, and reconstructed whole structures of MD neurons. While the main cortical projection targets of MDm, MDc, and MDl neurons were generally consistent with those of previous results, it was found that individual MD neurons sent their axon fibers to multiple prefrontal areas, and displayed various projection patterns in the target areas. Furthermore, the axons of single MD neurons were not homogeneously spread, but were rather distributed to form patchy axon arbors approximately 1 mm in diameter. The multiple-area projections and patchy axon arbors of single MD neurons might be able to coactivate cortical neuron groups in distant prefrontal areas simultaneously. Furthermore, considerable heterogeneity of the projection patterns is likely, to recruit the different sets of cortical neurons, and thus contributes to a variety of prefrontal functions. J. Comp. Neurol. 525:166-185, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Inbody, S B; Feng, A S
Binaural response properties of single neurons in the medial superior olivary nucleus (MSO) were investigated in the anesthetized rat. Stimulus parameters studied included interaural time difference and interaural intensity difference. In the present study, of the two cell types observed in the rat MSO nucleus, EE and EI, variations in the binaural response properties of the MSO neurons permitted further subclassifications, which may be related to the dendritic dominance of the MSO neurons.
Hage, Steffen R
Monkey vocalization is a complex behavioral pattern, which is flexibly used in audio-vocal communication. A recently proposed dual neural network model suggests that cognitive control might be involved in this behavior, originating from a frontal cortical network in the prefrontal cortex and mediated via projections from the rostral portion of the ventral premotor cortex (PMvr) and motor cortex to the primary vocal motor network in the brainstem. For the rapid adjustment of vocal output to external acoustic events, strong interconnections between vocal motor and auditory sites are needed, which are present at cortical and subcortical levels. However, the role of the PMvr in audio-vocal integration processes remains unclear. In the present study, single neurons in the PMvr were recorded in rhesus monkeys (Macaca mulatta) while volitionally producing vocalizations in a visual detection task or passively listening to monkey vocalizations. Ten percent of randomly selected neurons in the PMvr modulated their discharge rate in response to acoustic stimulation with species-specific calls. More than four-fifths of these auditory neurons showed an additional modulation of their discharge rates either before and/or during the monkeys' motor production of the vocalization. Based on these audio-vocal interactions, the PMvr might be well positioned to mediate higher order auditory processing with cognitive control of the vocal motor output to the primary vocal motor network. Such audio-vocal integration processes in the premotor cortex might constitute a precursor for the evolution of complex learned audio-vocal integration systems, ultimately giving rise to human speech. Copyright © 2018 Elsevier B.V. All rights reserved.
Home, P D; Jones, N P; Pocock, S J
AIMS: To compare glucose control over 18 months between rosiglitazone oral combination therapy and combination metformin and sulphonylurea in people with Type 2 diabetes. METHODS: RECORD, a multicentre, parallel-group study of cardiovascular outcomes, enrolled people with an HbA(1c) of 7.1-9.0% o......AIMS: To compare glucose control over 18 months between rosiglitazone oral combination therapy and combination metformin and sulphonylurea in people with Type 2 diabetes. METHODS: RECORD, a multicentre, parallel-group study of cardiovascular outcomes, enrolled people with an HbA(1c) of 7.......1-9.0% on maximum doses of metformin or sulphonylurea. If on metformin they were randomized to add-on rosiglitazone or sulphonylurea (open label) and if on sulphonylurea to rosiglitazone or metformin. HbA(1c) was managed to
Wang, Ting-Yuan; Chen, Nan-Yow; He, Guan-Wei; Wang, Guo-Tzau; Shih, Chi-Tin; Chiang, Ann-Shyn
Effective 3D visualization is essential for connectomics analysis, where the number of neural images easily reaches over tens of thousands. A formidable challenge is to simultaneously visualize a large number of distinguishable single-neuron images, with reasonable processing time and memory for file management and 3D rendering. In the present study, we proposed an algorithm named "Kaleido" that can visualize up to at least ten thousand single neurons from the Drosophila brain using only a fraction of the memory traditionally required, without increasing computing time. Adding more brain neurons increases memory only nominally. Importantly, Kaleido maximizes color contrast between neighboring neurons so that individual neurons can be easily distinguished. Colors can also be assigned to neurons based on biological relevance, such as gene expression, neurotransmitters, and/or development history. For cross-lab examination, the identity of every neuron is retrievable from the displayed image. To demonstrate the effectiveness and tractability of the method, we applied Kaleido to visualize the 10,000 Drosophila brain neurons obtained from the FlyCircuit database ( http://www.flycircuit.tw/modules.php?name=kaleido ). Thus, Kaleido visualization requires only sensible computer memory for manual examination of big connectomics data.
Homeostatic processes that provide negative feedback to regulate neuronal firing rate are essential for normal brain function, and observations suggest that multiple such processes may operate simultaneously in the same network. We pose two questions: why might a diversity of homeostatic pathways be necessary, and how can they operate in concert without opposing and undermining each other? To address these questions, we perform a computational and analytical study of cell-intrinsic homeostasis and synaptic homeostasis in single-neuron and recurrent circuit models. We demonstrate analytically and in simulation that when two such mechanisms are controlled on a long time scale by firing rate via simple and general feedback rules, they can robustly operate in tandem to tune the mean and variance of single neuron's firing rate to desired goals. This property allows the system to recover desired behavior after chronic changes in input statistics. We illustrate the power of this homeostatic tuning scheme by using it to regain high mutual information between neuronal input and output after major changes in input statistics. We then show that such dual homeostasis can be applied to tune the behavior of a neural integrator, a system that is notoriously sensitive to variation in parameters. These results are robust to variation in goals and model parameters. We argue that a set of homeostatic processes that appear to redundantly regulate mean firing rate may work together to control firing rate mean and variance and thus maintain performance in a parameter-sensitive task such as integration. PMID:27306675
1 Some basic neurophysiology 4 The neuron 1. 1 4 1. 1. 1 The axon 7 1. 1. 2 The synapse 9 12 1. 1. 3 The soma 1. 1. 4 The dendrites 13 13 1. 2 Types of neurons 2 Signals in the nervous system 14 2. 1 Action potentials as point events - point processes in the nervous system 15 18 2. 2 Spontaneous activi~ in neurons 3 Stochastic modelling of single neuron spike trains 19 3. 1 Characteristics of a neuron spike train 19 3. 2 The mathematical neuron 23 4 Superposition models 26 4. 1 superposition of renewal processes 26 4. 2 Superposition of stationary point processe- limiting behaviour 34 4. 2. 1 Palm functions 35 4. 2. 2 Asymptotic behaviour of n stationary point processes superposed 36 4. 3 Superposition models of neuron spike trains 37 4. 3. 1 Model 4. 1 39 4. 3. 2 Model 4. 2 - A superposition model with 40 two input channels 40 4. 3. 3 Model 4. 3 4. 4 Discussion 41 43 5 Deletion models 5. 1 Deletion models with 1nd~endent interaction of excitatory and inhibitory sequences 44 VI 5. 1. 1 Model 5. 1 The basic de...
Hage, Steffen R; Nieder, Andreas
Complex audio-vocal integration systems depend on a strong interconnection between the auditory and the vocal motor system. To gain cognitive control over audio-vocal interaction during vocal motor control, the PFC needs to be involved. Neurons in the ventrolateral PFC (VLPFC) have been shown to separately encode the sensory perceptions and motor production of vocalizations. It is unknown, however, whether single neurons in the PFC reflect audio-vocal interactions. We therefore recorded single-unit activity in the VLPFC of rhesus monkeys (Macaca mulatta) while they produced vocalizations on command or passively listened to monkey calls. We found that 12% of randomly selected neurons in VLPFC modulated their discharge rate in response to acoustic stimulation with species-specific calls. Almost three-fourths of these auditory neurons showed an additional modulation of their discharge rates either before and/or during the monkeys' motor production of vocalization. Based on these audio-vocal interactions, the VLPFC might be well positioned to combine higher order auditory processing with cognitive control of the vocal motor output. Such audio-vocal integration processes in the VLPFC might constitute a precursor for the evolution of complex learned audio-vocal integration systems, ultimately giving rise to human speech. Copyright © 2015 the authors 0270-6474/15/357030-11$15.00/0.
Villagran-Vargas, Edgar; Rodríguez-Sosa, Leonardo; Hustert, Reinhold; Blicher, Andreas; Laub, Katrine; Heimburg, Thomas
In this work, we analyzed the interpulse interval (IPI) of doublets and triplets in single neurons of three biological models. Pulse trains with two or three spikes originate from the process of sensory mechanotransduction in neurons of the locust femoral nerve, as well as through spontaneous activity both in the abdominal motor neurons and the caudal photoreceptor of the crayfish. We show that the IPI for successive low-frequency single action potentials, as recorded with two electrodes at two different points along a nerve axon, remains constant. On the other hand, IPI in doublets either remains constant, increases or decreases by up to about 3 ms as the pair propagates. When IPI increases, the succeeding pulse travels at a slower speed than the preceding one. When IPI is reduced, the succeeding pulse travels faster than the preceding one and may exceed the normal value for the specific neuron. In both cases, IPI increase and reduction, the speed of the preceding pulse differs slightly from the normal value, therefore the two pulses travel at different speeds in the same nerve axon. On the basis of our results, we may state that the effect of attraction or repulsion in doublets suggests a tendency of the spikes to reach a stable configuration. We strongly suggest that the change in IPI during spike propagation of doublets opens up a whole new realm of possibilities for neural coding and may have major implications for understanding information processing in nervous systems. Copyright © 2012 Wiley Periodicals, Inc.
Liu Yan; Xia Hong
As one of the main type of reactors in the future, the development of the integral reactor has attracted worldwide attention. On the basis of understanding the background of the integral reactor, the author will be familiar with and master the power control of reactor and the feedwater flow control of steam generator, and the speed control of turbine (turbine speed control is associated with the turbine load control). According to the expectative program 'reactor power following turbine load' of the reactor, it will make coordinate control of the three and come to a overall control scheme. The author will use the supervisory learning algorithm of Hebb for single neuron PID controller with self-adaptation to study the coordinate control of integral reactor. Compared with conventional PI or PID controller, to a certain extent, it solves the problems that traditional PID controller is not easy to tune real-time parameters and lack of effective control for a number of complex processes and slow-varying parameter systems. It improves the security, reliability, stability and flexibility of control process and achieves effective control of the system. (authors)
Mouterde, Solveig C; Elie, Julie E; Mathevon, Nicolas; Theunissen, Frédéric E
One of the most complex tasks performed by sensory systems is "scene analysis": the interpretation of complex signals as behaviorally relevant objects. The study of this problem, universal to species and sensory modalities, is particularly challenging in audition, where sounds from various sources and localizations, degraded by propagation through the environment, sum to form a single acoustical signal. Here we investigated in a songbird model, the zebra finch, the neural substrate for ranging and identifying a single source. We relied on ecologically and behaviorally relevant stimuli, contact calls, to investigate the neural discrimination of individual vocal signature as well as sound source distance when calls have been degraded through propagation in a natural environment. Performing electrophysiological recordings in anesthetized birds, we found neurons in the auditory forebrain that discriminate individual vocal signatures despite long-range degradation, as well as neurons discriminating propagation distance, with varying degrees of multiplexing between both information types. Moreover, the neural discrimination performance of individual identity was not affected by propagation-induced degradation beyond what was induced by the decreased intensity. For the first time, neurons with distance-invariant identity discrimination properties as well as distance-discriminant neurons are revealed in the avian auditory cortex. Because these neurons were recorded in animals that had prior experience neither with the vocalizers of the stimuli nor with long-range propagation of calls, we suggest that this neural population is part of a general-purpose system for vocalizer discrimination and ranging. SIGNIFICANCE STATEMENT Understanding how the brain makes sense of the multitude of stimuli that it continually receives in natural conditions is a challenge for scientists. Here we provide a new understanding of how the auditory system extracts behaviorally relevant information
Kebschull, Justus M; Garcia da Silva, Pedro; Reid, Ashlan P; Peikon, Ian D; Albeanu, Dinu F; Zador, Anthony M
Neurons transmit information to distant brain regions via long-range axonal projections. In the mouse, area-to-area connections have only been systematically mapped using bulk labeling techniques, which obscure the diverse projections of intermingled single neurons. Here we describe MAPseq (Multiplexed Analysis of Projections by Sequencing), a technique that can map the projections of thousands or even millions of single neurons by labeling large sets of neurons with random RNA sequences ("barcodes"). Axons are filled with barcode mRNA, each putative projection area is dissected, and the barcode mRNA is extracted and sequenced. Applying MAPseq to the locus coeruleus (LC), we find that individual LC neurons have preferred cortical targets. By recasting neuroanatomy, which is traditionally viewed as a problem of microscopy, as a problem of sequencing, MAPseq harnesses advances in sequencing technology to permit high-throughput interrogation of brain circuits. Copyright © 2016 Elsevier Inc. All rights reserved.
Doron, Guy; von Heimendahl, Moritz; Schlattmann, Peter; Houweling, Arthur R; Brecht, Michael
The action potential activity of single cortical neurons can evoke measurable sensory effects, but it is not known how spiking parameters and neuronal subtypes affect the evoked sensations. Here, we examined the effects of spike train irregularity, spike frequency, and spike number on the detectability of single-neuron stimulation in rat somatosensory cortex. For regular-spiking, putative excitatory neurons, detectability increased with spike train irregularity and decreasing spike frequencies but was not affected by spike number. Stimulation of single, fast-spiking, putative inhibitory neurons led to a larger sensory effect compared to regular-spiking neurons, and the effect size depended only on spike irregularity. An ideal-observer analysis suggests that, under our experimental conditions, rats were using integration windows of a few hundred milliseconds or more. Our data imply that the behaving animal is sensitive to single neurons' spikes and even to their temporal patterning. Copyright © 2014 Elsevier Inc. All rights reserved.
Rao, Qiang; Xiao, Chi; Han, Hua; Chen, Xi; Shen, Lijun; Xie, Qiwei
Extracting the structure of single neurons is critical for understanding how they function within the neural circuits. Recent developments in microscopy techniques, and the widely recognized need for openness and standardization provide a community resource for automated reconstruction of dendritic and axonal morphology of single neurons. In order to look into the fine structure of neurons, we use the Automated Tape-collecting Ultra Microtome Scanning Electron Microscopy (ATUM-SEM) to get images sequence of serial sections of animal brain tissue that densely packed with neurons. Different from other neuron reconstruction method, we propose a method that enhances the SEM images by detecting the neuronal membranes with deep convolutional neural network (DCNN) and segments single neurons by active contour with group shape similarity. We joint the segmentation and tracing together and they interact with each other by alternate iteration that tracing aids the selection of candidate region patch for active contour segmentation while the segmentation provides the neuron geometrical features which improve the robustness of tracing. The tracing model mainly relies on the neuron geometrical features and is updated after neuron being segmented on the every next section. Our method enables the reconstruction of neurons of the drosophila mushroom body which is cut to serial sections and imaged under SEM. Our method provides an elementary step for the whole reconstruction of neuronal networks.
Schneider, David M; Woolley, Sarah M N
Many social animals including songbirds use communication vocalizations for individual recognition. The perception of vocalizations depends on the encoding of complex sounds by neurons in the ascending auditory system, each of which is tuned to a particular subset of acoustic features. Here, we examined how well the responses of single auditory neurons could be used to discriminate among bird songs and we compared discriminability to spectrotemporal tuning. We then used biologically realistic models of pooled neural responses to test whether the responses of groups of neurons discriminated among songs better than the responses of single neurons and whether discrimination by groups of neurons was related to spectrotemporal tuning and trial-to-trial response variability. The responses of single auditory midbrain neurons could be used to discriminate among vocalizations with a wide range of abilities, ranging from chance to 100%. The ability to discriminate among songs using single neuron responses was not correlated with spectrotemporal tuning. Pooling the responses of pairs of neurons generally led to better discrimination than the average of the two inputs and the most discriminating input. Pooling the responses of three to five single neurons continued to improve neural discrimination. The increase in discriminability was largest for groups of neurons with similar spectrotemporal tuning. Further, we found that groups of neurons with correlated spike trains achieved the largest gains in discriminability. We simulated neurons with varying levels of temporal precision and measured the discriminability of responses from single simulated neurons and groups of simulated neurons. Simulated neurons with biologically observed levels of temporal precision benefited more from pooling correlated inputs than did neurons with highly precise or imprecise spike trains. These findings suggest that pooling correlated neural responses with the levels of precision observed in the
Feng, Peihua; Wu, Ying; Zhang, Jiazhong
Non-linear behaviors of a single neuron described by Fitzhugh-Nagumo (FHN) neuron model, with external electromagnetic radiation considered, is investigated. It is discovered that with external electromagnetic radiation in form of a cosine function, the mode selection of membrane potential occurs among periodic, quasi-periodic, and chaotic motions as increasing the frequency of external transmembrane current, which is selected as a sinusoidal function. When the frequency is small or large enough, periodic, and quasi-periodic motions are captured alternatively. Otherwise, when frequency is in interval 0.778 electromagnetic radiation. The frequency apparently plays a more important role in determining the system behavior.
Full Text Available Neural Networks (NN have proved its efficacy for nonlinear system modeling. NN based controllers and estimators for nonlinear systems provide promising alternatives to the conventional counterpart. However, NN models have to meet the stringent requirements on execution time for its effective use in real time applications. This requires the NN model to be structurally compact and computationally less complex. In this paper a parametric method of analysis is adopted to determine the compact and faster NN model among various neural network architectures. This work proves through analysis and examples that the Single Neuron Cascaded (SNC architecture is distinct in providing compact and simpler models requiring lower execution time. The unique structural growth of SNC architecture enables automation in design. The SNC Network is shown to combine the advantages of both single and multilayer neural network architectures. Extensive analysis on selected architectures and their models for four benchmark nonlinear theoretical plants and a practical application are tested. A performance comparison of the NN models is presented to demonstrate the superiority of the single neuron cascaded architecture for online real time applications.
Ryan T Canolty
Full Text Available Understanding the principles governing the dynamic coordination of functional brain networks remains an important unmet goal within neuroscience. How do distributed ensembles of neurons transiently coordinate their activity across a variety of spatial and temporal scales? While a complete mechanistic account of this process remains elusive, evidence suggests that neuronal oscillations may play a key role in this process, with different rhythms influencing both local computation and long-range communication. To investigate this question, we recorded multiple single unit and local field potential (LFP activity from microelectrode arrays implanted bilaterally in macaque motor areas. Monkeys performed a delayed center-out reach task either manually using their natural arm (Manual Control, MC or under direct neural control through a brain-machine interface (Brain Control, BC. In accord with prior work, we found that the spiking activity of individual neurons is coupled to multiple aspects of the ongoing motor beta rhythm (10-45 Hz during both MC and BC, with neurons exhibiting a diversity of coupling preferences. However, here we show that for identified single neurons, this beta-to-rate mapping can change in a reversible and task-dependent way. For example, as beta power increases, a given neuron may increase spiking during MC but decrease spiking during BC, or exhibit a reversible shift in the preferred phase of firing. The within-task stability of coupling, combined with the reversible cross-task changes in coupling, suggest that task-dependent changes in the beta-to-rate mapping play a role in the transient functional reorganization of neural ensembles. We characterize the range of task-dependent changes in the mapping from beta amplitude, phase, and inter-hemispheric phase differences to the spike rates of an ensemble of simultaneously-recorded neurons, and discuss the potential implications that dynamic remapping from oscillatory activity to
Full Text Available Non-linear behaviors of a single neuron described by Fitzhugh-Nagumo (FHN neuron model, with external electromagnetic radiation considered, is investigated. It is discovered that with external electromagnetic radiation in form of a cosine function, the mode selection of membrane potential occurs among periodic, quasi-periodic, and chaotic motions as increasing the frequency of external transmembrane current, which is selected as a sinusoidal function. When the frequency is small or large enough, periodic, and quasi-periodic motions are captured alternatively. Otherwise, when frequency is in interval 0.778 < ω < 2.208, chaotic motion characterizes the main behavior type. The mechanism of mode transition from quasi-periodic to chaotic motion is also observed when varying the amplitude of external electromagnetic radiation. The frequency apparently plays a more important role in determining the system behavior.
Burton, H; Sinclair, R J
Clinical and neuroimaging observations of the cortical network implicated in tactile attention have identified foci in parietal somatosensory, posterior parietal, and superior frontal locations. Tasks involving intentional hand-arm movements activate similar or nearby parietal and frontal foci. Visual spatial attention tasks and deliberate visuomotor behavior also activate overlapping posterior parietal and frontal foci. Studies in the visual and somatosensory systems thus support a proposal that attention to the spatial location of an object engages cortical regions responsible for the same coordinate referents used for guiding purposeful motor behavior. Tactile attention also biases processing in the somatosensory cortex through amplification of responses to relevant features of selected stimuli. Psychophysical studies demonstrate retention gradients for tactile stimuli like those reported for visual and auditory stimuli, and suggest analogous neural mechanisms for working memory across modalities. Neuroimaging studies in humans using memory tasks, and anatomic studies in monkeys support the idea that tactile information relayed from the somatosensory cortex is directed ventrally through the insula to the frontal cortex for short-term retention and to structures of the medial temporal lobe for long-term encoding. At the level of single neurons, tactile (such as visual and auditory) short-term memory appears as a persistent response during delay intervals between sampled stimuli.
Full Text Available Optogenetic approaches using light-activated proteins like Channelrhodopsin-2 (ChR2 enable investigating the function of populations of neurons in live Caenorhabditis elegans (and other animals, as ChR2 expression can be targeted to these cells using specific promoters. Sub-populations of these neurons, or even single cells, can be further addressed by restricting the illumination to the cell of interest. However, this is technically demanding, particularly in free moving animals. Thus, it would be helpful if expression of ChR2 could be restricted to single neurons or neuron pairs, as even wide-field illumination would photostimulate only this particular cell. To this end we adopted the use of Cre or FLP recombinases and conditional ChR2 expression at the intersection of two promoter expression domains, i.e. in the cell of interest only. Success of this method depends on precise knowledge of the individual promoters' expression patterns and on relative expression levels of recombinase and ChR2. A bicistronic expression cassette with GFP helps to identify the correct expression pattern. Here we show specific expression in the AVA reverse command neurons and the aversive polymodal sensory ASH neurons. This approach shall enable to generate strains for optogenetic manipulation of each of the 302 C. elegans neurons. This may eventually allow to model the C. elegans nervous system in its entirety, based on functional data for each neuron.
For the past 10 or more years, Analytical Laboratory data cards have been generated and stored in the 222-S Laboratory at the Hanford Site in Richland, Washington. These cards are classified as record material and require retention for a minimum of 75 years in an approved storage facility in accordance with Westinghouse Hanford Company procedures. The cards are maintained in records boxes in the attic of the 222-S Laboratory and are subject to potential risk and loss. The most significant potential risks are radiological hazards. Various options are available for removal, cataloging, transmittal, and storage of these long-term records. Because the records are currently stored in a radiation protection zone, they surveyed before being released from the facility. This survey can be arduous and time consuming. Resolutions to the problem of removal and proper storage of the records from the facility need to be addressed. The records were reviewed and inventoried to determine the quantity of information. A study of the various options available was conducted, and based on the information collected, it was determined that the most feasible and cost-effective approach is to microfilm the cards inside the laboratory. This option complies with all applicable company requirements and decreases the estimated radiological survey time from approximately 3.5 years to under 40 hours. This activity will result in a potential savings of $350,000 over the life of the activity
Full Text Available Experiment has demonstrated that summation of excitatory post-synaptic protientials (EPSPs in dendrites is non-linear. The sum of multiple EPSPs can be larger than their arithmetic sum, a superlinear summation due to the opening of voltage-gated channels and similar to somatic spiking. The so-called dendritic spike. The sum of multiple of EPSPs can also be smaller than their arithmetic sum, because the synaptic current necessarily saturates at some point. While these observations are well-explained by biophysical models the impact of dendritic spikes on computation remains a matter of debate. One reason is that dendritic spikes may fail to make the neuron spike; similarly, dendritic saturations are sometime presented as a glitch which should be corrected by dendritic spikes. We will provide solid arguments against this claim and show that dendritic saturations as well as dendritic spikes enhance single neuron computation, even when they cannot directly make the neuron fire. To explore the computational impact of dendritic spikes and saturations, we are using a binary neuron model in conjunction with Boolean algebra. We demonstrate using these tools that a single dendritic non-linearity, either spiking or saturating, combined with somatic non-linearity, enables a neuron to compute linearly non-separable Boolean functions (lnBfs. These functions are impossible to compute when summation is linear and the exclusive OR is a famous example of lnBfs. Importantly, the implementation of these functions does not require the dendritic non-linearity to make the neuron spike. Next, We show that reduced and realistic biophysical models of the neuron are capable of computing lnBfs. Within these models and contrary to the binary model, the dendritic and somatic non-linearity are tightly coupled. Yet we show that these neuron models are capable of linearly non-separable computations.
Munro, Paul Wesley
A special form for modification of neuronal response properties is described in which the change in the synaptic state vector is parallel to the vector of afferent activity. This process is termed "parallel modification" and its theoretical and experimental implications are examined. A theoretical framework has been devised to describe the complementary functions of generalization and discrimination by single neurons. This constitutes a basis for three models each describing processes for the development of maximum selectivity (discrimination) and minimum selectivity (generalization) by neurons. Strengthening and weakening of synapses is expressed as a product of the presynaptic activity and a nonlinear modulatory function of two postsynaptic variables--namely a measure of the spatially integrated activity of the cell and a temporal integration (time-average) of that activity. Some theorems are given for low-dimensional systems and computer simulation results from more complex systems are discussed. Model neurons that achieve high selectivity mimic the development of cat visual cortex neurons in a wide variety of rearing conditions. A role for low-selectivity neurons is proposed in which they provide inhibitory input to neurons of the opposite type, thereby suppressing the common component of a pattern class and enhancing their selective properties. Such contrast-enhancing circuits are analyzed and supported by computer simulation. To enable maximum selectivity, the net inhibition to a cell must become strong enough to offset whatever excitation is produced by the non-preferred patterns. Ramifications of parallel models for certain experimental paradigms are analyzed. A methodology is outlined for testing synaptic modification hypotheses in the laboratory. A plastic projection from one neuronal population to another will attain stable equilibrium under periodic electrical stimulation of constant intensity. The perturbative effect of shifting this intensity level
Full Text Available Understanding plasticity of neural networks is a key to comprehending their development and function. A powerful technique to study neural plasticity includes recording and control of pre- and postsynaptic neural activity, e.g., by using simultaneous intracellular recording and stimulation of several neurons. Intracellular recording is, however, a demanding technique and has its limitations in that only a small number of neurons can be stimulated and recorded from at the same time. Extracellular techniques offer the possibility to simultaneously record from larger numbers of neurons with relative ease, at the expenses of increased efforts to sort out single neuronal activities from the recorded mixture, which is a time consuming and error prone step, referred to as spike sorting. In this mini-review, we describe recent technological developments in two separate fields, namely CMOS-based high-density microelectrode arrays, which also allow for extracellular stimulation of neurons, and real-time spike sorting. We argue that these techniques, when combined, will provide a powerful tool to study plasticity in neural networks consisting of several thousand neurons in vitro.
Franke, Felix; Jäckel, David; Dragas, Jelena; Müller, Jan; Radivojevic, Milos; Bakkum, Douglas; Hierlemann, Andreas
Understanding plasticity of neural networks is a key to comprehending their development and function. A powerful technique to study neural plasticity includes recording and control of pre- and post-synaptic neural activity, e.g., by using simultaneous intracellular recording and stimulation of several neurons. Intracellular recording is, however, a demanding technique and has its limitations in that only a small number of neurons can be stimulated and recorded from at the same time. Extracellular techniques offer the possibility to simultaneously record from larger numbers of neurons with relative ease, at the expenses of increased efforts to sort out single neuronal activities from the recorded mixture, which is a time consuming and error prone step, referred to as spike sorting. In this mini-review, we describe recent technological developments in two separate fields, namely CMOS-based high-density microelectrode arrays, which also allow for extracellular stimulation of neurons, and real-time spike sorting. We argue that these techniques, when combined, will provide a powerful tool to study plasticity in neural networks consisting of several thousand neurons in vitro.
Ambadekar, N N; Khandait, D W; Zodpey, S P; Kasturwar, N B; Vasudeo, N D
Present record based study was undertaken in Medical record section of Government medical college, Nagpur, to assess teenage as a risk factor for pregnancy complications, outcome, and operative or assisted delivery. Five year (January 1993 to December 1997) data was scanned, which gave sample of 1830 teenage pregnancies; while equal number of subsequent partly matched controls (> 20.29 years) were taken. Results showed proportion of low birth weight baby to be significantly greater in teenagers (p pregnancies (p pregnancy, premature rupture of membrane, placenta previa, accidental haemorrhage though more in adult pregnancies was statistically not significant. There were no differences in cogenital anamoly and twins between cases and controls. But breech deliveries were significantly (p < 0.001) more in adults.
Miura, Tomohiro; Nakamoto, Takamichi; Moriizumi, Toyosaka
It is necessary to determine the recipe of a target odor with sufficient accuracy to realize an odor recorder for recording and reproducing it. We studied the recipe measurement method of a target odor using a mass spectrometry. It was confirmed that the linear superposition was valid when the binary mixture of the apple-flavor components such as isobutyric acid and ethyl valerate was measured. The superposition of a mass spectrum pattern may enable the recipe determination of a multi-component odor easily. In this research, we succeeded in the recipe determinations of orange flavor made up of 14 component odors when its typical recipe, the equalized, the citral-enhanced and the citronellol-enhanced ones were measured.
Kansas State Dept. of Education, Topeka.
Personal record management practices must reflect contemporary concerns for the rights of the individual. Recent legislation, court decisions, and the rapid expansion of computerized record systems all point to the need for new procedures in personal record keeping. Although this paper is addressed particularly to educational agencies responsibile…
Wang, Zhen; Wang, Xiaohong; Li, Yuxia; Huang, Xia
In this paper, the problems of stability and Hopf bifurcation in a class of fractional-order complex-valued single neuron model with time delay are addressed. With the help of the stability theory of fractional-order differential equations and Laplace transforms, several new sufficient conditions, which ensure the stability of the system are derived. Taking the time delay as the bifurcation parameter, Hopf bifurcation is investigated and the critical value of the time delay for the occurrence of Hopf bifurcation is determined. Finally, two representative numerical examples are given to show the effectiveness of the theoretical results.
He, Na; Kong, Lingzhi; Lin, Tao; Wang, Shaohui; Liu, Xiuping; Qi, Jiyao; Yan, Jun
Binaural hearing confers many beneficial functions but our understanding of its underlying neural substrates is limited. This study examines the bilateral synaptic assemblies and binaural computation (or integration) in the central nucleus of the inferior colliculus (ICc) of the auditory midbrain, a key convergent center. Using in-vivo whole-cell patch-clamp, the excitatory and inhibitory postsynaptic potentials (EPSPs/IPSPs) of single ICc neurons to contralateral, ipsilateral and bilateral stimulation were recorded. According to the contralateral and ipsilateral EPSP/IPSP, 7 types of bilateral synaptic assemblies were identified. These include EPSP-EPSP (EE), E-IPSP (EI), E-no response (EO), II, IE, IO and complex-mode (CM) neurons. The CM neurons showed frequency- and/or amplitude-dependent EPSPs/IPSPs to contralateral or ipsilateral stimulation. Bilateral stimulation induced EPSPs/IPSPs that could be larger than (facilitation), similar to (ineffectiveness) or smaller than (suppression) those induced by contralateral stimulation. Our findings have allowed our group to characterize novel neural circuitry for binaural computation in the midbrain. Copyright © 2017 Elsevier B.V. All rights reserved.
Siegel, Jennifer J
A number of studies indicate that the medial prefrontal cortex (mPFC) plays a role in mediating the expression of behavioral responses during tasks that require flexible changes in behavior. During trace eyeblink conditioning, evidence suggests that the mPFC provides the cerebellum with a persistent input to bridge the temporal gap between conditioned and unconditioned stimuli. Therefore, the mPFC is in a position to directly mediate the expression of trace conditioned responses. However, it is unknown whether persistent neural responses are associated with the flexible expression of behavior when task contingencies are changed during trace eyeblink conditioning. To investigate this, single-unit activity was recorded in the mPFC of rabbits during extinction and reacquisition of trace eyeblink conditioning, and during training to a different conditional stimulus. Persistent responses remained unchanged after full extinction, and also did not change during reacquisition training. During training to a different tone, however, the generalization of persistent responses to the new stimulus was associated with an animal's performance-when persistent responses generalized to the new tone, performance was high (>50% response rate). When persistent responses decreased to baseline rates, performance was poor (<50% response rate). The data suggest that persistent mPFC responses do not appear to mediate flexible changes in the expression of the original learning, but do appear to play a role in the generalization of that learning when the task is modified.
Kottas, Athanasios; Behseta, Sam
We propose a fully inferential model-based approach to the problem of comparing the firing patterns of a neuron recorded under two distinct experimental conditions. The methodology is based on nonhomogeneous Poisson process models for the firing times of each condition with flexible nonparametric mixture prior models for the corresponding intensity functions. We demonstrate posterior inferences from a global analysis, which may be used to compare the two conditions over the entire experimental time window, as well as from a pointwise analysis at selected time points to detect local deviations of firing patterns from one condition to another. We apply our method on two neurons recorded from the primary motor cortex area of a monkey's brain while performing a sequence of reaching tasks.
checklist (before StaL- fled In Appendix B of this Part- IfD Each flight recorder required by Ins engines for the purpose of fljg- (1) Time, altitude...gisetrici&I power glictli dse of this sucetion must meet be installed so that- from the bus ithat provides, the mai- Me uffinh-um Performsnce Btandard
Vargas-Irwin, Carlos E.; Brandman, David M.; Zimmermann, Jonas B.; Donoghue, John P.; Black, Michael J.
Increased emphasis on circuit level activity in the brain makes it necessary to have methods to visualize and evaluate large scale ensemble activity, beyond that revealed by raster-histograms or pairwise correlations. We present a method to evaluate the relative similarity of neural spiking patterns by combining spike train distance metrics with dimensionality reduction. Spike train distance metrics provide an estimate of similarity between activity patterns at multiple temporal resolutions. Vectors of pair-wise distances are used to represent the intrinsic relationships between multiple activity patterns at the level of single units or neuronal ensembles. Dimensionality reduction is then used to project the data into concise representations suitable for clustering analysis as well as exploratory visualization. Algorithm performance and robustness are evaluated using multielectrode ensemble activity data recorded in behaving primates. We demonstrate how Spike train SIMilarity Space (SSIMS) analysis captures the relationship between goal directions for an 8-directional reaching task and successfully segregates grasp types in a 3D grasping task in the absence of kinematic information. The algorithm enables exploration of virtually any type of neural spiking (time series) data, providing similarity-based clustering of neural activity states with minimal assumptions about potential information encoding models. PMID:25380335
Full Text Available Existing current based models that capture spike activity, though useful in studying information processing capabilities of neurons, fail to throw light on their internal functioning. It is imperative to develop a model that captures the spike train of a neuron as a function of its intra cellular parameters for non-invasive diagnosis of diseased neurons. This is the first ever article to present such an integrated model that quantifies the inter-dependency between spike activity and intra cellular energetics. The generated spike trains from our integrated model will throw greater light on the intra-cellular energetics than existing current models. Now, an abnormality in the spike of a diseased neuron can be linked and hence effectively analyzed at the energetics level. The spectral analysis of the generated spike trains in a time-frequency domain will help identify abnormalities in the internals of a neuron. As a case study, the parameters of our model are tuned for Alzheimer disease and its resultant spike trains are studied and presented.
Fabbro, Alessandra; Bosi, Susanna; Ballerini, Laura; Prato, Maurizio
In the past decade, nanotechnology applications to the nervous system have often involved the study and the use of novel nanomaterials to improve the diagnosis and therapy of neurological diseases. In the field of nanomedicine, carbon nanotubes are evaluated as promising materials for diverse therapeutic and diagnostic applications. Besides, carbon nanotubes are increasingly employed in basic neuroscience approaches, and they have been used in the design of neuronal interfaces or in that of scaffolds promoting neuronal growth in vitro. Ultimately, carbon nanotubes are thought to hold the potential for the development of innovative neurological implants. In this framework, it is particularly relevant to document the impact of interfacing such materials with nerve cells. Carbon nanotubes were shown, when modified with biologically active compounds or functionalized in order to alter their charge, to affect neurite outgrowth and branching. Notably, purified carbon nanotubes used as scaffolds can promote the formation of nanotube-neuron hybrid networks, able per se to affect neuron integrative abilities, network connectivity, and synaptic plasticity. We focus this review on our work over several years directed to investigate the ability of carbon nanotube platforms in providing a new tool for nongenetic manipulations of neuronal performance and network signaling.
Rodríguez, Ana R.; O'Neill, Kate M.; Swiatkowski, Przemyslaw; Patel, Mihir V.; Firestein, Bonnie L.
Objective. This study investigates the effect that overexpression of cytosolic PSD-95 interactor (cypin), a regulator of synaptic PSD-95 protein localization and a core regulator of dendrite branching, exerts on the electrical activity of rat hippocampal neurons and networks. Approach. We cultured rat hippocampal neurons and used lipid-mediated transfection and lentiviral gene transfer to achieve high levels of cypin or cypin mutant (cypinΔPDZ PSD-95 non-binding) expression cellularly and network-wide, respectively. Main results. Our analysis revealed that although overexpression of cypin and cypinΔPDZ increase dendrite numbers and decrease spine density, cypin and cypinΔPDZ distinctly regulate neuronal activity. At the single cell level, cypin promotes decreases in bursting activity while cypinΔPDZ reduces sEPSC frequency and further decreases bursting compared to cypin. At the network level, by using the Fano factor as a measure of spike count variability, cypin overexpression results in an increase in variability of spike count, and this effect is abolished when cypin cannot bind PSD-95. This variability is also dependent on baseline activity levels and on mean spike rate over time. Finally, our spike sorting data show that overexpression of cypin results in a more complex distribution of spike waveforms and that binding to PSD-95 is essential for this complexity. Significance. Our data suggest that dendrite morphology does not play a major role in cypin action on electrical activity.
Uzuntarla, M.; Ozer, M.; Ileri, U.; Calim, A.; Torres, J. J.
The noise-delayed decay (NDD) phenomenon emerges when the first-spike latency of a periodically forced stochastic neuron exhibits a maximum for a particular range of noise intensity. Here, we investigate the latency response dynamics of a single Hodgkin-Huxley neuron that is subject to both a suprathreshold periodic stimulus and a background activity arriving through dynamic synapses. We study the first-spike latency response as a function of the presynaptic firing rate f . This constitutes a more realistic scenario than previous works, since f provides a suitable biophysically realistic parameter to control the level of activity in actual neural systems. We first report on the emergence of classical NDD behavior as a function of f for the limit of static synapses. Second, we show that when short-term depression and facilitation mechanisms are included at the synapses, different NDD features can be found due to their modulatory effect on synaptic current fluctuations. For example, an intriguing double NDD (DNDD) behavior occurs for different sets of relevant synaptic parameters. Moreover, depending on the balance between synaptic depression and synaptic facilitation, single NDD or DNDD can prevail, in such a way that synaptic facilitation favors the emergence of DNDD whereas synaptic depression favors the existence of single NDD. Here we report the existence of the DNDD effect in the response latency dynamics of a neuron.
Dimitrios V Vavoulis
Full Text Available Traditional approaches to the problem of parameter estimation in biophysical models of neurons and neural networks usually adopt a global search algorithm (for example, an evolutionary algorithm, often in combination with a local search method (such as gradient descent in order to minimize the value of a cost function, which measures the discrepancy between various features of the available experimental data and model output. In this study, we approach the problem of parameter estimation in conductance-based models of single neurons from a different perspective. By adopting a hidden-dynamical-systems formalism, we expressed parameter estimation as an inference problem in these systems, which can then be tackled using a range of well-established statistical inference methods. The particular method we used was Kitagawa's self-organizing state-space model, which was applied on a number of Hodgkin-Huxley-type models using simulated or actual electrophysiological data. We showed that the algorithm can be used to estimate a large number of parameters, including maximal conductances, reversal potentials, kinetics of ionic currents, measurement and intrinsic noise, based on low-dimensional experimental data and sufficiently informative priors in the form of pre-defined constraints imposed on model parameters. The algorithm remained operational even when very noisy experimental data were used. Importantly, by combining the self-organizing state-space model with an adaptive sampling algorithm akin to the Covariance Matrix Adaptation Evolution Strategy, we achieved a significant reduction in the variance of parameter estimates. The algorithm did not require the explicit formulation of a cost function and it was straightforward to apply on compartmental models and multiple data sets. Overall, the proposed methodology is particularly suitable for resolving high-dimensional inference problems based on noisy electrophysiological data and, therefore, a
Full Text Available The generation of complex neural circuits depends on the correct wiring of neurons with diverse individual characteristics. To understand the complexity of the nervous system, the molecular mechanisms for specifying the identity and diversity of individual neurons must be elucidated. The clustered protocadherins (Pcdh in mammals consist of approximately 50 Pcdh genes (Pcdh-α, Pcdh-β, and Pcdh-γ that encode cadherin-family cell surface adhesion proteins. Individual neurons express a random combination of Pcdh-α and Pcdh-γ, whereas the expression patterns for the Pcdh-β genes, 22 one-exon genes in mouse, are not fully understood. Here we show that the Pcdh-β genes are expressed in a 3’-polyadenylated form in mouse brain. In situ hybridization using a pan-Pcdh-β probe against a conserved Pcdh-β sequence showed widespread labeling in the brain, with prominent signals in the olfactory bulb, hippocampus, and cerebellum. In situ hybridization with specific probes for individual Pcdh-β genes showed their expression to be scattered in Purkinje cells from P10 to P150. The scattered expression patterns were confirmed by performing a newly developed single-cell 3’-RACE analysis of Purkinje cells, which clearly demonstrated that the Pcdh-β genes are expressed monoallelically and combinatorially in individual Purkinje cells. Scattered expression patterns of individual Pcdh-β genes were also observed in pyramidal neurons in the hippocampus and cerebral cortex, neurons in the trigeminal and dorsal root ganglion, GABAergic interneurons, and cholinergic neurons. Our results extend previous observations of diversity at the single-neuron level generated by Pcdh expression and suggest that the Pcdh-β cluster genes contribute to specifying the identity and diversity of individual neurons.
Pedro Luiz Cortês
Full Text Available The importance of patient records, also known as medical records, is related to different needs and objectives, as they constitute permanent documents on the health of patients. With the advancement of information technologies and systems, patient records can be stored in databases, resulting in a positive impact on patient care. Based on these considerations, a research question that arises is “what are the benefits and problems that can be seen with the use of electronic versions of medical records?” This question leads to the formulation of the following hypothesis: although problems can be identified during the process of using electronic record systems, the benefits outweigh the difficulties, thereby justifying their use. To respond to the question and test the presented hypothesis, a research study was developed with users of the same electronic record system, consisting of doctors, nurses, and administrative personnel in three hospitals located in the city of São Paulo, Brazil. The results show that, despite some problems in their usage, the benefits of electronic patient records outweigh possible disadvantages.
Systematic records of solar eclipses started from Chunqiu period. Such records are complete and regular from the Han to the Qing Dynasties. Before then, in the Xia, Shang and West Zhou Dynasties, records of solar eclipses were vague and scattered. Many people investigated them, but it is difficult to get final conclusions. With recent progress in astronomical computation and historic chronology, new achievements have been reached in studies of early solar eclipses. These records include "Sanmiao" and "Zhongkang" eclipses in the legends of the Xia Dynasty; "Three flames ate the Sun", "The sun and the moon were eclipsed" and "The sun was Zhi" on the oracle bones of the Shang Dynasty; "Tianda yi", "Double dawn" and "Poem eclipse" in the literature of West Zhou Dynasty.
Full Text Available The aim of this study is to carry out a bibliographical review of the ways in which spatial categories have been approached within poor people's employment record studies. The significance of this research lies on the fact that, even though the perspectives from which the concept of "record" emerges give precedence to the analysis of time and space dimensions, the latter has only been scarcely studied. Within such framework, our paper aims to analyze how the space variable is constructed in various empirical investigations and which contributions are made by the record perspective to space variable studies. To approach the issue, we will focus on those spatial categories of analysis which allow us to discern the new characteristics and consequences underlying the spatial segregation phenomenon. Special emphasis will be given to the neighborhood space
Lisboa, Tania; Chaffin, Roger; Demos, Alexander P
Musicians generally believe that memory differs from one person to the next. As a result, memorizing strategies that could be useful to almost everyone are not widely taught. We describe how an 18-years old piano student (Grade 7, ABRSM), learned to memorize by recording her thoughts, a technique inspired by studies of how experienced soloists memorize. The student, who had previously ignored suggestions that she play from memory, decided to learn to memorize, selecting Schumann's "Der Dichter Spricht" for this purpose. Rather than explicitly teaching the student how to memorize, the teacher taught her to record her thoughts while playing by marking them on copies of the score, adapting an approach used previously in research with experienced performers. Over a 6½ week period, the student recorded her thoughts during practice (five times) and while performing from memory for the teacher (three times). The student also video-recorded 3 weeks of practice, three performances, and the reconstruction of the piece from memory after a 9½-weeks break. The thoughts that the student reported were prepared during practice, stable over time, and functioned as memory retrieval cues during reconstruction. This suggests that the student memorized in the same way as the more experienced musicians who have been studied previously and that teaching student musicians to record their thoughts may be an effective way to help them memorize. The speed and durability of her memorization surprised the student, inspiring her to perform in public and to use the same technique for new pieces.
Jan 9, 2013 ... E-mail: firstname.lastname@example.org. MS received 13 February 2012; revised 3 July 2012; accepted 24 July 2012. Abstract. The aim of the present work is to make a comparative study of the EXAFS spectra recorded at the BL-8 dispersive EXAFS beamline at 2 GeV Indus-2 synchrotron source at RRCAT,.
Perry, Jeffrey J; Sutherland, Jane; Symington, Cheryl; Dorland, Katie; Mansour, Marlene; Stiell, Ian G
Electronic medical records are becoming an integral part of healthcare delivery. The goal of this study was to compare paper documentation versus electronic medical record for non-traumatic chest pain to determine differences in time for physicians to complete medical records using paper versus electronic mediums. We also assessed physician satisfaction with the electronic format. We conducted this before-after study in a single large tertiary care academic emergency department. In the 'Before Period', stopwatches determined the time for paper medical recording. In the 'After Period', a template-based electronic medical record was introduced and the time for electronic recording was measured. The time to record in the before and after periods were compared using a two-sided t test. We surveyed physicians to assess satisfaction. We enrolled 100 non-traumatic patients with chest pain in the before period and 73 in the after period. The documentation time was longer using electronic charting, (9.6±5.9 min vs 6.1±2.5 min; pelectronic patient recording for non-traumatic chest pain. This is the first study that we are aware of which compared paper versus electronic medical records in the emergency department. Electronic recording took longer than paper records. Physicians were not satisfied using this electronic record. Given the time pressures on emergency physicians, a solution to minimise the charting time using electronic medical records must be found before widespread uptake of electronic charting will be possible. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Lisboa, Tania; Chaffin, Roger; Demos, Alexander P.
Musicians generally believe that memory differs from one person to the next. As a result, memorizing strategies that could be useful to almost everyone are not widely taught. We describe how an 18-years old piano student (Grade 7, ABRSM), learned to memorize by recording her thoughts, a technique inspired by studies of how experienced soloists memorize. The student, who had previously ignored suggestions that she play from memory, decided to learn to memorize, selecting Schumann’s “Der Dichter Spricht” for this purpose. Rather than explicitly teaching the student how to memorize, the teacher taught her to record her thoughts while playing by marking them on copies of the score, adapting an approach used previously in research with experienced performers. Over a 6½ week period, the student recorded her thoughts during practice (five times) and while performing from memory for the teacher (three times). The student also video-recorded 3 weeks of practice, three performances, and the reconstruction of the piece from memory after a 9½-weeks break. The thoughts that the student reported were prepared during practice, stable over time, and functioned as memory retrieval cues during reconstruction. This suggests that the student memorized in the same way as the more experienced musicians who have been studied previously and that teaching student musicians to record their thoughts may be an effective way to help them memorize. The speed and durability of her memorization surprised the student, inspiring her to perform in public and to use the same technique for new pieces. PMID:25667574
Full Text Available Musicians generally believe that memory differs from one person to the next. As a result, memorizing strategies that could be useful to almost everyone are not widely taught. We describe how an 18-year old piano student (Grade 7, ABRSM, learned to memorize by recording her thoughts, a technique inspired by studies of how experienced soloists memorize. The student, who had previously ignored suggestions that she play from memory, decided to learn to memorize, selecting Schumann’s Der Dichter Spricht for this purpose. Rather than explicitly teaching the student how to memorize, the teacher taught her to record her thoughts while playing by marking them on copies of the score, adapting an approach used previously in research with experienced performers. Over a 6½ week period, the student recorded her thoughts during practice (5 times and while performing from memory for the teacher (3 times. The student also video-recorded three weeks of practice, three performances, and the reconstruction of the piece from memory after a 9½-weeks break. The thoughts that the student reported were prepared during practice, stable over time, and functioned as memory retrieval cues during reconstruction. This suggests that the student memorized in the same way as the more experienced musicians who have been studied previously and that teaching student musicians to record their thoughts may be an effective way to help them memorize. The speed and durability of her memorization surprised the student, inspiring her to perform in public and to use the same technique for new pieces.
Kent, Alexander R.; Grill, Warren M.
Objective. Closed-loop deep brain stimulation (DBS) systems have the potential to optimize treatment of movement disorders by enabling automatic adjustment of stimulation parameters based on a feedback signal. Evoked compound action potentials (ECAPs) and local field potentials (LFPs) recorded from the DBS electrode may serve as suitable closed-loop control signals. The objective of this study was to understand better the factors that influence ECAP and LFP recording, including the physical presence of the electrode, the geometrical dimensions of the electrode, and changes in the composition of the peri-electrode space across recording conditions. Approach. Coupled volume conductor-neuron models were used to calculate single-unit activity as well as ECAP responses and LFP activity from a population of model thalamic neurons. Main results. Comparing ECAPs and LFPs measured with and without the presence of the highly conductive recording contacts, we found that the presence of these contacts had a negligible effect on the magnitude of single-unit recordings, ECAPs (7% RMS difference between waveforms), and LFPs (5% change in signal magnitude). Spatial averaging across the contact surface decreased the ECAP magnitude in a phase-dependent manner (74% RMS difference), resulting from a differential effect of the contact on the contribution from nearby or distant elements, and decreased the LFP magnitude (25% change). Reductions in the electrode diameter or recording contact length increased signal energy and increased spatial sensitivity of single neuron recordings. Moreover, smaller diameter electrodes (500 µm) were more selective for recording from local cells over passing axons, with the opposite true for larger diameters (1500 µm). Changes in electrode dimensions had phase-dependent effects on ECAP characteristics, and generally had small effects on the LFP magnitude. ECAP signal energy and LFP magnitude decreased with tighter contact spacing (100 µm), compared to
Schofield, Peter W; Lee, Stephen J; Davies, Graeme C
To determine whether a tape recorder can be used to administer cognitive tests efficiently and yield valid results. Convenience sample. Administration of cognitive test materials by tape recorder and conventional technique. Outpatient clinic. Subjects from memory disorder clinic, hostel accommodation, and community. Responses to Hopkins Verbal Learning Test-revised, verbal fluency items from the controlled oral word association test, 10-item naming task, a construction task, and speed writing task. Performances on the tape- and clinician-administered battery of tests were highly correlated. Memory impairment was accurately detected using the tape battery. Data from 30 minutes of testing via tape were obtained at the cost to the clinician of 2 to 3 minutes of scoring time. Tape-administration of cognitive test material warrants further study as an efficient means of cognitive screening.
Kraman, Steve S; Wodicka, George R; Kiyokawa, Hiroshi; Pasterkamp, Hans
Digital audio tape (DAT) recorders have become the de facto gold standard recording devices for lung sounds. Sound recorded on DAT is compact-disk (CD) quality with adequate sensitivity from below 20 Hz to above 20 KHz. However, DAT recorders have drawbacks. Although small, they are relatively heavy, the recording mechanism is complex and delicate, and finding one desired track out of many is inconvenient. A more recent development in portable recording devices is the minidisc (MD) recorder. These recorders are widely available, inexpensive, small and light, rugged, mechanically simple, and record digital data in tracks that may be named and accessed directly. Minidiscs hold as much recorded sound as a compact disk but in about 1/5 of the recordable area. The data compression is achieved by use of a technique known as adaptive transform acoustic coding for minidisc (ATRAC). This coding technique makes decisions about what components of the sound would not be heard by a human listener and discards the digital information that represents these sounds. Most of this compression takes place on sounds above 5.5 KHz. As the intended use of these recorders is the storage and reproduction of music, it is unknown whether ATRAC will discard or distort significant portions of typical lung sound signals. We determined the suitability of MD recorders for respiratory sound research by comparing a variety of normal and pathologic lung sounds that were digitized directly into a computer and also after recording by a DAT recorder and 2 different MD recorders (Sharp and Sony). We found that the frequency spectra and waveforms of respiratory sounds were not distorted in any important way by recording on the two MD recorders tested.
Full Text Available Although Ottoman document types have been studied, documents of the Republican era have not yet been sufficiently studied. Academic studies and university publications of recent years can be seen as promising developments, albeit quite inadequate considering the hundreds of documents in institutions. It is thought that a classification of records types will assist users in various fields of study such as administrative law, public administration and history and in records-information management fields such as archives and electronic records management. In particular, the metadata tag of document type is an important element in electronic records management applications. In this article, records of the Republican period are evaluated. Samples collected in field work done in the 2000s are evaluated in light of the regulations that are the grounds for its being produced. Records of the Republican period are considered modern documents and have been classified according to common features of types. The records are classified according to methods of modern diplomatics. Due to its length, the article is divided into two parts. In this first part, “dispositive records” are discussed.
Beierle, Thomas C.; Cayford, Jerry
Public participation has received increasing attention in environmental policy making world wide. Yet research has been inadequate to answer fundamental questions about how successful past programs have been, what factors lead to success, and where efforts to improve public involvement should focus. To address these questions, we examine the case study record of public participation efforts in the United States over the last 30 years. We evaluate the success of numerous examples of public participation in environmental decision making and identify the factors that lead to success. The paper deals with a number of themes, including: The extent to which participation can incorporate public values into decision making, improve the substantive quality of decisions, reduce conflict, increase trust in institutions, and educate and inform the public; What can be expected from different approaches to public participation, such as public meetings, advisory committees, and mediation; The relative importance of the participatory process vs. the context in which participation takes place; Procedural features of particular importance; and The relationship between participation and implementation. The paper provides general results that can be used to guide the improvement of public participation programs, support assessment of innovative methods, and advance the theoretical understanding of public participation
Buitenweg, Jan R.; Rutten, Wim; Marani, Enrico
Amplitudes and shapes of extracellular recordings from single neurons cultured on a substrate embedded microelectrode depend not only on the volume conducting properties of the neuron-electrode interface, but might also depend on the distribution of voltage-sensitive channels over the neuronal
Boone, Deborah R; Sell, Stacy L; Hellmich, Helen Lee
Long-term cognitive disability after TBI is associated with injury-induced neurodegeneration in the hippocampus-a region in the medial temporal lobe that is critical for learning, memory and executive function. Hence our studies focus on gene expression analysis of specific neuronal populations in distinct subregions of the hippocampus. The technique of laser capture microdissection (LCM), introduced in 1996 by Emmert-Buck, et al., has allowed for significant advances in gene expression analysis of single cells and enriched populations of cells from heterogeneous tissues such as the mammalian brain that contains thousands of functional cell types. We use LCM and a well established rat model of traumatic brain injury (TBI) to investigate the molecular mechanisms that underlie the pathogenesis of TBI. Following fluid-percussion TBI, brains are removed at pre-determined times post-injury, immediately frozen on dry ice, and prepared for sectioning in a cryostat. The rat brains can be embedded in OCT and sectioned immediately, or stored several months at -80 °C before sectioning for laser capture microdissection. Additionally, we use LCM to study the effects of TBI on circadian rhythms. For this, we capture neurons from the suprachiasmatic nuclei that contain the master clock of the mammalian brain. Here, we demonstrate the use of LCM to obtain single identified neurons (injured and degenerating, Fluoro-Jade-positive, or uninjured, Fluoro-Jade-negative) and enriched populations of hippocampal neurons for subsequent gene expression analysis by real time PCR and/or whole-genome microarrays. These LCM-enabled studies have revealed that the selective vulnerability of anatomically distinct regions of the rat hippocampus are reflected in the different gene expression profiles of different populations of neurons obtained by LCM from these distinct regions. The results from our single-cell studies, where we compare the transcriptional profiles of dying and adjacent surviving
Sadeh, Sadra; Rotter, Stefan
The neuronal mechanisms underlying the emergence of orientation selectivity in the primary visual cortex of mammals are still elusive. In rodents, visual neurons show highly selective responses to oriented stimuli, but neighboring neurons do not necessarily have similar preferences. Instead of a smooth map, one observes a salt-and-pepper organization of orientation selectivity. Modeling studies have recently confirmed that balanced random networks are indeed capable of amplifying weakly tuned inputs and generating highly selective output responses, even in absence of feature-selective recurrent connectivity. Here we seek to elucidate the neuronal mechanisms underlying this phenomenon by resorting to networks of integrate-and-fire neurons, which are amenable to analytic treatment. Specifically, in networks of perfect integrate-and-fire neurons, we observe that highly selective and contrast invariant output responses emerge, very similar to networks of leaky integrate-and-fire neurons. We then demonstrate that a theory based on mean firing rates and the detailed network topology predicts the output responses, and explains the mechanisms underlying the suppression of the common-mode, amplification of modulation, and contrast invariance. Increasing inhibition dominance in our networks makes the rectifying nonlinearity more prominent, which in turn adds some distortions to the otherwise essentially linear prediction. An extension of the linear theory can account for all the distortions, enabling us to compute the exact shape of every individual tuning curve in our networks. We show that this simple form of nonlinearity adds two important properties to orientation selectivity in the network, namely sharpening of tuning curves and extra suppression of the modulation. The theory can be further extended to account for the nonlinearity of the leaky model by replacing the rectifier by the appropriate smooth input-output transfer function. These results are robust and do not
It has been shown that the results obtained from the EXAFS spectra recorded at the BL-8 beamline are comparable with those obtained from other synchrotron EXAFS beamlines and also with the crystallographic results reported by earlier workers. The reliability, usefulness and data quality of the BL-8 beamline have been ...
Wallace, Patricia Erwin
A study was made of career-ladder positions that are available to students studying records management at various education levels to determine the tasks that are performed by records management personnel at various employment levels and to determine the tasks that should be included in records management courses. (CT)
Through the practices of recording, psychiatric nurses produce clinical knowledge about the patients in their care. The objective of this study was to examine the conventionalized practices of recording among psychiatric nurses and the typical linguistic organization of their records. The study drew on data from an extended fieldwork on two Danish "special observation" wards. The results indicated that the nurses' recording produced "stereotyping" representations of the patients and reduced the nurses' clinical knowledge but that this particular way of recording made good sense in relation to the social organization at the wards.
Tavakoli, Nahid; Jahanbakhsh, Maryam; Akbari, Mojtaba; Baktashian, Mojtba; Hasanzadeh, Akbar; Sadeghpour, Samaneh
Background: The rate of hospital deductions is a commonly cited concern among teaching hospitals in Iran. The objective of the present study is to access the effect of the quantitative and qualitative analysis of inpatient medical records on deductions and identifying the major resources of deductions. There are currently no published interventional studies that have investigated this issue quantitatively. Materials and Methods: In an interventional study, we reviewed all the 192 patient's medical records (PMRs) for any documentation errors, to determine the rate of deductions. We conducted a pilot of 30 cases prior to the actual survey. Nonprobability-based consecutive sampling was used. The main study was conducted in three phases: 1. Primary evaluation; 2. Training, performance of intervention and corrective actions; and 3. Final assessment. Comprehensive assessments of medical records and follow-upof error correction were carried out systematically and according to the pre-set schedule. Pre- and post-intervention assessments were compared in order to evaluate the effect of the intervention. Data were analyzed using the SPSS-20 statistical software. Paired-sample t-test was used to compare changes in deduction scores before and after the intervention. Differences at a P value less than 0.05 were considered statistically significant. Results: In the initial survey of 800 PMRs, nearly one quarter (24%) (Or 192 cases) had at least one type of deduction. The three top types of deductions were Laboratory (47.9%), Medical radiation (45.3%), and Physician visit (35.9%). The results showed a 2.7- to about 36-fold lower rate of hospital deductions (average: 6.4-fold; reduction from21131 to 3285 US dollars). Conclusion: All in all, the results of the present study indicated that educational interventions and quantitative and qualitative analysis of inpatient medical records are very beneficial and effective in the reduction of medical record deductions. PMID:26097852
Löfhede, Johan; Seoane, Fernando; Thordstein, Magnus
The overall aim of our research is to develop a monitoring system for neonatal intensive care units. Long-term EEG monitoring in newborns require that the electrodes don't harm the sensitive skin of the baby, an especially relevant feature for premature babies. Our approach to EEG monitoring is based on several electrodes distributed over the head of the baby, and since the weight of the head always will be on some of them, any type of hard electrode will inevitably cause a pressure-point that can irritate the skin. Therefore, we propose the use of soft conductive textiles as EEG electrodes, primarily for neonates, but also for other kinds of unobtrusive long-term monitoring. In this paper we have tested two types of textile electrodes on five healthy adults and compared them to standard high quality electrodes. The acquired signals were compared with respect to morphology, frequency distribution, spectral coherence, correlation and power line interference sensitivity, and the signals were found to be similar in most respects. The good measurement performance exhibited by the textile electrodes indicates that they are feasible candidates for EEG recording, opening the door for long-term EEG monitoring applications.
Löfhede, Johan; Seoane, Fernando; Thordstein, Magnus
The overall aim of our research is to develop a monitoring system for neonatal intensive care units. Long-term EEG monitoring in newborns require that the electrodes don’t harm the sensitive skin of the baby, an especially relevant feature for premature babies. Our approach to EEG monitoring is based on several electrodes distributed over the head of the baby, and since the weight of the head always will be on some of them, any type of hard electrode will inevitably cause a pressure-point that can irritate the skin. Therefore, we propose the use of soft conductive textiles as EEG electrodes, primarily for neonates, but also for other kinds of unobtrusive long-term monitoring. In this paper we have tested two types of textile electrodes on five healthy adults and compared them to standard high quality electrodes. The acquired signals were compared with respect to morphology, frequency distribution, spectral coherence, correlation and power line interference sensitivity, and the signals were found to be similar in most respects. The good measurement performance exhibited by the textile electrodes indicates that they are feasible candidates for EEG recording, opening the door for long-term EEG monitoring applications. PMID:23223149
Full Text Available The overall aim of our research is to develop a monitoring system for neonatal intensive care units. Long-term EEG monitoring in newborns require that the electrodes don’t harm the sensitive skin of the baby, an especially relevant feature for premature babies. Our approach to EEG monitoring is based on several electrodes distributed over the head of the baby, and since the weight of the head always will be on some of them, any type of hard electrode will inevitably cause a pressure-point that can irritate the skin. Therefore, we propose the use of soft conductive textiles as EEG electrodes, primarily for neonates, but also for other kinds of unobtrusive long-term monitoring. In this paper we have tested two types of textile electrodes on five healthy adults and compared them to standard high quality electrodes. The acquired signals were compared with respect to morphology, frequency distribution, spectral coherence, correlation and power line interference sensitivity, and the signals were found to be similar in most respects. The good measurement performance exhibited by the textile electrodes indicates that they are feasible candidates for EEG recording, opening the door for long-term EEG monitoring applications.
Full Text Available -carrying capacity of the pillars. Physical measurements of pillar deformations were deemed necessary. Towards this end, the use of ground ARMA/USRMS 06-1168 A study of mine stability...
Wallois, F.; Mahmoudzadeh, M.; Patil, A.; Grebe, R.
One of the most challenging tasks in neuroscience in language studies, is investigation of the brain's ability to integrate and process information. This task can only be successfully addressed by applying various assessment techniques integrated into a multimodal approach. Each of these techniques has its advantages and disadvantages, but help to…
Palchykov, Vasyl; Kertesz, Janos; Dunbar, Robin; Kaski, Kimmo
Mobile phone communication as digital service generates ever-increasing datasets of human communication actions, which in turn allow us to investigate the structure and evolution of social interactions and their networks. These datasets can be used to study the structuring of such egocentric networks with respect to the strength of the relationships by assuming direct dependence of the communication intensity on the strength of the social tie. Recently we have discovered that there are signif...
Kalfayan, S. H.; Silver, R. H.; Hoffman, J. K.
Methods were developed for measuring frictional forces acting on a magnetic tape in motion or at rest, as well as the extent of stick slip. The effects of factors such as temperature, humidity, kind of gaseous atmosphere, and tape speed on the frictional interaction between various tapes and heads were investigated. Results were instrumental in the selection of a tape for the Mariner Mars 1971 spacecraft. Studies are reported on the stick slip behavior of tapes and the performance of a metallic tape, compared with the usual plastic tapes.
Chen, Chang Hao; Pun, Sio Hang; Mak, Peng Un; Vai, Mang I; Klug, Achim; Lei, Tim C
Glass micropipettes are widely used to record neural activity from single neurons or clusters of neurons extracellularly in live animals. However, to date, there has been no comprehensive study of noise in extracellular recordings with glass micropipettes. The purpose of this work was to assess various noise sources that affect extracellular recordings and to create model systems in which novel micropipette neural amplifier designs can be tested. An equivalent circuit of the glass micropipette and the noise model of this circuit, which accurately describe the various noise sources involved in extracellular recordings, have been developed. Measurement schemes using dead brain tissue as well as extracellular recordings from neurons in the inferior colliculus, an auditory brain nucleus of an anesthetized gerbil, were used to characterize noise performance and amplification efficacy of the proposed micropipette neural amplifier. According to our model, the major noise sources which influence the signal to noise ratio are the intrinsic noise of the neural amplifier and the thermal noise from distributed pipette resistance. These two types of noise were calculated and measured and were shown to be the dominating sources of background noise for in vivo experiments.
Chang Hao Chen
Full Text Available Glass micropipettes are widely used to record neural activity from single neurons or clusters of neurons extracellularly in live animals. However, to date, there has been no comprehensive study of noise in extracellular recordings with glass micropipettes. The purpose of this work was to assess various noise sources that affect extracellular recordings and to create model systems in which novel micropipette neural amplifier designs can be tested. An equivalent circuit of the glass micropipette and the noise model of this circuit, which accurately describe the various noise sources involved in extracellular recordings, have been developed. Measurement schemes using dead brain tissue as well as extracellular recordings from neurons in the inferior colliculus, an auditory brain nucleus of an anesthetized gerbil, were used to characterize noise performance and amplification efficacy of the proposed micropipette neural amplifier. According to our model, the major noise sources which influence the signal to noise ratio are the intrinsic noise of the neural amplifier and the thermal noise from distributed pipette resistance. These two types of noise were calculated and measured and were shown to be the dominating sources of background noise for in vivo experiments.
Lee, K.R.; Cox, G.G.; Templeton, A.W.; Preston, D.F.; Anderson, W.H.; Hensley, K.S.; Dwyer, S.J.
The increase in the use of various imaging modalities demands higher quality and more efficacious analog image recordings. Laser electronic recordings with digital array prints of 4,000 x 5,000 x 12 bits obtained using laser-sensitive film or paper are being evaluated. Dry silver paper recordings are being improved and evaluated. High-resolution paper dot printers are being studied to determine their gray-scale capabilities. The authors evaluated the image quality, costs, clinical utilization, and acceptability of CT scans, MR images, digital subtraction angiograms, digital radiographs, and radionuclide scans recorded by seven different printers (three laser, three silver paper, and one dot) and compared the same features in conventional film recording. This exhibit outlines the technical developments and instrumentation of digital laser film and analog paper recorders and presents the results of the study
Palchykov, Vasyl; Kertész, János; Dunbar, Robin; Kaski, Kimmo
Mobile phone communication as digital service generates ever-increasing datasets of human communication actions, which in turn allow us to investigate the structure and evolution of social interactions and their networks. These datasets can be used to study the structuring of such egocentric networks with respect to the strength of the relationships by assuming direct dependence of the communication intensity on the strength of the social tie. Recently we have discovered that there are significant differences between the first and further "best friends" from the point of view of age and gender preferences. Here we introduce a control parameter p max based on the statistics of communication with the first and second "best friend" and use it to filter the data. We find that when p max is decreased the identification of the "best friend" becomes less ambiguous and the earlier observed effects get stronger, thus corroborating them.
Davies-Kershaw, Hilary; Petersen, Irene; Nazareth, Irwin; Stevenson, Fiona
Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower. To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies. A semi-structured qualitative interview study of GPs working in general practices across England. Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis. The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR. When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies. © British Journal of General Practice 2018.
Gupta, Anamika; Mishra, Gaurav; Bhutani, Hemant; Hoshing, Chetan; Bhalla, Ashish
Objectives: With the growth of forensic odontology, dental records have become an essential source of information, especially for medicolegal cases in general practice. It is mandated by the law that every dentist must keep some kind of records for every patient they treat. After the death of an individual, remnants of teeth are usually damaged at the last among all body parts. Dental records assist in personal identification in cases of mass disasters, criminal investigations, and medicolegal issues. However, in India, rules for maintaining dental records are not very strictly followed. Thus, the aim of this study was to evaluate the knowledge regarding the maintenance of dental records among dentists in Punjab and Uttar Pradesh. Materials and Methods: Data collection was performed via a questionnaire. The study population responded to the questions pertaining to knowledge regarding forensic odontology methods and the mode of maintaining dental records in their regular practice through a personal interview. A descriptive analysis was carried out for the data. The data were summarized and analyzed using the statistical software Statistical Package for the Social Sciences (SPSS) version 18.0. Results: A very low percentage (22%) of the dentists were seen to be maintaining records on a regular basis. Seventy-eight percent of the dentists were not maintaining any records. Conclusion: This study clearly indicates that the dentists in Punjab and Uttar Pradesh need to be properly trained for any kind of forensic and medicolegal needs. PMID:27583219
The primary purpose of this guide is to describe each series of records which pertains to studies of worker health and mortality funded by the U.S. Department of Energy (DOE) at the Hanford site. Additionally, the guide provides information on the location and classification of the records and how they may be accessed. History Associates Incorporated (HAI) prepared this guide as part of its work as the support services contractor for DOE`s Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI`s role in the project, the history of the DOE and the Hanford site, and Hanford`s organizational structure. It provides information on the methodology used to inventory and describe pertinent records stored in various onsite offices, in Hanford`s Records Holding Area (RHA), and at the Seattle Federal Records Center (SFRC). Other topics include the methodology used to produce the guide, the arrangement of the record Series descrimations, and information on accessing records repositories.
Prior, Helen; Bottomley, Anna; Champéroux, Pascal; Cordes, Jason; Delpy, Eric; Dybdal, Noel; Edmunds, Nick; Engwall, Mike; Foley, Mike; Hoffmann, Michael; Kaiser, Robert; Meecham, Ken; Milano, Stéphane; Milne, Aileen; Nelson, Rick; Roche, Brian; Valentin, Jean-Pierre; Ward, Gemma; Chapman, Kathryn
The Safety Pharmacology Society (SPS) and National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs) conducted a survey and workshop in 2015 to define current industry practices relating to housing of non-rodents during telemetry recordings in safety pharmacology and toxicology studies. The aim was to share experiences, canvas opinion on the study procedures/designs that could be used and explore the barriers to social housing. Thirty-nine sites, either running studies (Sponsors or Contract Research Organisations, CROs) and/or outsourcing work responded to the survey (51% from Europe; 41% from USA). During safety pharmacology studies, 84, 67 and 100% of respondents socially house dogs, minipigs and non-human primates (NHPs) respectively on non-recording days. However, on recording days 20, 20 and 33% of respondents socially house the animals, respectively. The main barriers for social housing were limitations in the recording equipment used, study design and animal temperament/activity. During toxicology studies, 94, 100 and 100% of respondents socially house dogs, minipigs and NHPs respectively on non-recording days. However, on recording days 31, 25 and 50% of respondents socially house the animals, respectively. The main barriers for social housing were risk of damage to and limitations in the recording equipment used, food consumption recording and temperament/activity of the animals. Although the majority of the industry does not yet socially house animals during telemetry recordings in safety pharmacology and toxicology studies, there is support to implement this refinement. Continued discussions, sharing of best practice and data from companies already socially housing, combined with technology improvements and investments in infrastructure are required to maintain the forward momentum of this refinement across the industry. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Sharma, P. P.; Gervasoni, G.; Albisetti, E.; D'Ercoli, F.; Monticelli, M.; Moretti, D.; Forte, N.; Rocchi, A.; Ferrari, G.; Baldelli, P.; Sampietro, M.; Benfenati, F.; Bertacco, R.; Petti, D.
A promising strategy to get deeper insight on brain functionalities relies on the investigation of neural activities at the cellular and sub-cellular level. In this framework, methods for recording neuron electrical activity have gained interest over the years. Main technological challenges are associated to finding highly sensitive detection schemes, providing considerable spatial and temporal resolution. Moreover, the possibility to perform non-invasive assays would constitute a noteworthy benefit. In this work, we present a magnetoresistive platform for the detection of the action potential propagation in neural cells. Such platform allows, in perspective, the in vitro recording of neural signals arising from single neurons, neural networks and brain slices.
The Medical & Research Study Records of Human Volunteers System collects demographic and medical information on subjects who participate in research. Learn how this data is collected, used, access to the data, and the purpose of data collection.
Benchimol, Eric I; Smeeth, Liam; Guttmann, Astrid; Harron, Katie; Hemkens, Lars G; Moher, David; Petersen, Irene; Sørensen, Henrik T; von Elm, Erik; Langan, Sinéad M
Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist as well as explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included. This document, as well as the accompanying website and message board (http://www.record-statement.org), will improve the implementation and understanding of RECORD. By implementing RECORD, authors, journals editors, and peer reviewers can enhance transparency of research reporting. Copyright © 2016. Published by Elsevier GmbH.
Benchimol, Eric I; Smeeth, Liam; Guttmann, Astrid; Harron, Katie; Moher, David; Petersen, Irene; Sørensen, Henrik T; von Elm, Erik; Langan, Sinéad M
Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org), will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.
Benchimol, Eric I.; Smeeth, Liam; Guttmann, Astrid; Harron, Katie; Moher, David; Petersen, Irene; Sørensen, Henrik T.; von Elm, Erik; Langan, Sinéad M.
Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org), will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting. PMID:26440803
Eric I Benchimol
Full Text Available Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE. The REporting of studies Conducted using Observational Routinely collected health Data (RECORD statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org, will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.
Cassidy, John; Hill, Mimi J.
One of the geomagnetic excursions recorded in basalts of the Auckland volcanic field, New Zealand, has recently been correlated unequivocally with the Mono Lake excursion, making it the only confirmed record from the southern hemisphere. This record is also exceptional in occurring in five separate monogenetic basaltic volcanoes. Absolute palaeointensity determinations using the microwave technique, based on a comprehensive suite of samples of the Auckland basalts recording the excursion, show that the geomagnetic field in New Zealand at the time of the Mono Lake excursion was reduced to about 14 μT i.e. to 30% of its normal value. This result confirms previous estimates based on more limited sampling. In addition, it provides a comparison of the microwave and LDT-DHT Shaw methods of measuring palaeointensity, which give results that are statistically indistinguishable. The palaeointensities determined from the five different volcanoes are also indistinguishable, though the palaeodirection data suggest that a very small segment of the VGP path may have been recorded. This study confirms the reliability of palaeointensity and palaeodirection determinations from these particular New Zealand basalts, which together with their definitive 40Ar/ 39Ar ages, establishes this record of the Mono Lake excursion as one of the best documented. Consequently, there is significant potential in searching for records of this excursion elsewhere in the Pacific region for use as a stratigraphic marker in studies of recent volcanism and palaeoclimate reconstructions.
Mothersill, J. S.
The first study of the paleomagnetic record of lacustrine sedimentary sequences was published by Mackereth (1971) for Lake Windemere, England. Subsequently, lacustrine sedimentary sequence studies were carried out for Lake Erie (Creer et al., 1976) and Lake Michigan (Creer et al., 1976). This was followed by studies of Lake Superior (Mothersill, 1979) and Lake Huron (Mothersill, 1981). Based on the records from these four lakes Creer and Tucholka (1982) compiled "type" paleomagnetic records for east-central North America utilizing C14 for age control. Sprowl and Banerjee (1985) provided a comparable record utilizing varved sediments for dating purposes from Elk Lake, Minnesota. Over the past three decades a number of researchers have utilized paleomagnetic studies of the sediments of the Great Lakes Basin to date post- glacial lake stages as well as other events. Similar paleomagnetic studies of lakes in British Columbia were carried out by Turner (1987) and Mothersill (1991, 1994) utilizing Mackereth compressed air corers. In parts of British Columbia the Mt. St. Helens (3300 yrs.BP) and the Mt. Mazama (6845 yrs,BP) tephras provide time control for these records. These records tie in well with the work of Verosub et al. (1986) from Fish Lake, Oregon.
Lezaic, Visnja; Marinkovic, Jelena; Milutinovic, Zoran; Jovanovic-Vasiljevic, Nada; Vujicic, Vesna; Pejovic, Branka; Kalabic, Snezana; Djukanovic, Ljubica
In 2009, Belgrade nephrologists and general practitioners from thirteen health centers carried out screening for chronic kidney disease (CKD). Three years later, medical records of patients from four health centers participating in the screening study were retrospectively analyzed in order to check whether general practitioners had continued to control patients at risk for CKD in accordance with the recommendations provided. The study included 460 patients who visited their doctor at least once in the three-year period. Data on blood pressure, ACEI use, estimated glomerular filtration rate (eGFR) and comorbidities were taken from patients' medical records. Blood pressure was not recorded in any of the three years in 42.8% and eGFR in 36.7% of the patients, but blood pressure was registered every year in 7.8% and eGFR in 4.3% of them. Over the three years, the relative number of patients with recorded blood pressure decreased from 41.7% to 17.8%, and with recorded eGFR from 41.7% to 21.5%. Multivariate linear regression found that Health Center, systolic and diastolic blood pressure and presence of hypertension were negatively associated with number of years with recorded blood pressure. Health Center, systolic blood pressure and sum of years with recorded eGFR below 60 ml/min/1.73m 2 were associated with number of years with recorded eGFR. Under-recording of blood pressure and eGFR in primary care health centers suggests lack of adherence to current guidelines and insufficient care of CKD patients. This implies the necessity for continuous education of physicians.
Honda, Yukio; Tanahashi, Kiwamu; Hirayama, Yoshiyuki; Kikukawa, Atsushi; Futamoto, Masaaki
Magnetic force microscopy was used to study the magnetic interaction between the recording and the soft magnetic layers in double-layer perpendicular media by observing the magnetization structure from the soft magnetic layer side. There was a strong magnetic interaction between the recording and the soft magnetic layers. Introducing a thin nonmagnetic intermediate layer between the two layers greatly reduced the magnetic interaction and drastically reduced the medium noise
Eigenbrode, Jennifer L.
The geological preservation of lipids from the cell membranes of organisms bestows a precious record of ancient life, especially for the Precambrian eon (>542 million years ago) when Earth life was largely microbial. All organisms produce lipids that, if the lipids survive oxidative degradation, become molecular fossils entrained with information on biological diversity, environmental conditions, and post-depositional alteration history. As with most biosignatures, the molecular fossil record that is indigenous (of the same place) and syngenetic (of the same age) to host rocks can be compromised by the introduction from and reaction with foreign or younger materials (e.g., petroleum or endolithic life). Deciphering the resulting complex pool of organic signals requires tests for the provenance of molecular fossils and the overall quality of the geobiological record itself. This paper reviews the basis for the very existence of a molecular fossil record from lipid biochemistry to mechanisms of organic-matter preservation and geochemical alteration. A systematic approach to resolving the provenance of molecular fossils and historical qualities of the record is presented in a case study of an early Earth record. This example demonstrates the value of geological context and the integration of independent geobiological parameters, which are critical to the detection and understanding of the ecological processes responsible for records of life.
Woods, Susan S; Schwartz, Erin; Tuepker, Anais; Press, Nancy A; Nazi, Kim M; Turvey, Carolyn L; Nichol, W Paul
Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. A qualitative study with purposeful sampling sought to examine patients' views and experiences with reading their health records, including their clinical notes, online. Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared
... National Park Service Record of Decision, Long Walk National Historic Trail Feasibility Study/Abbreviated... Environmental Impact Statement for the Long Walk National Historic Trail Feasibility Study. SUMMARY: Pursuant to... Statement for the Long Walk National Historic Trail Feasibility Study, prepared by National Trails...
Discusses catalog records for non-English books created by European booksellers and loaded into OCLC; describes a study of Italian language monographs to compare vendor records with Library of Congress and OCLC member libraries' records; and considers changes in cataloging workflow needed to edit records to include Library of Congress call numbers…
Taylor, Anna; Stapley, Sally; Hamilton, William
Jaundice is a rare but important symptom of malignant and benign conditions. When patients present in primary care, understanding the relative likelihood of different disease processes can help GPs to investigate and refer patients appropriately. To identify and quantify the various causes of jaundice in adults presenting in primary care. Historical cohort study using electronic primary care records. UK General Practice Research Database. Participants (186 814 men and women) aged >45 years with clinical events recorded in primary care records between 1 January 2005 and 31 December 2007. Data were searched for episodes of jaundice and explanatory diagnoses identified within the subsequent 12 months. If no diagnosis was found, the patient's preceding medical record was searched for relevant chronic diseases. From the full cohort, 277 patients had at least one record of jaundice between 1 January 2005 and 31 December 2006. Ninety-two (33%) were found to have bile duct stones; 74 (27%) had an explanatory cancer [pancreatic cancer 34 (12%), cholangiocarcinoma 13 (5%) and other diagnosed primary malignancy 27 (10%)]. Liver disease attributed to excess alcohol explained 26 (9%) and other diagnoses were identified in 24 (9%). Sixty-one (22%) had no diagnosis related to jaundice recorded. Although the most common cause of jaundice is bile duct stones, cancers are present in over a quarter of patients with jaundice in this study, demonstrating the importance of urgent investigation into the underlying cause.
safety was achieved from many safeguards including reducing transcription errors and prescribing errors (Charles, Harmon, and Jordan). One major...receive continuing education as needed for reporting errors . Each coder spent up to two hours per week correcting administrative errors (BPR CHCS II...Management of these records is the responsibility of the Head of the Clinic. Section VI Medico -Legal Issues 16-35. General. (1) Purpose - include
Full Text Available We explore the concept that artists perform best in front of an audience. The negative effects of performance anxiety are much better known than their related cousin on the other shoulder: the positive effects of social facilitation. The present study, however, reveals a listener's preference for performances recorded in front of an audience. In Study 1, we prepared two types of recordings of Träumerei performed by 13 pianists: recordings in front of an audience and those with no audience. According to the evaluation by 153 listeners, the recordings performed in front of an audience sounded better, suggesting that the presence of an audience enhanced or facilitated the performance. In Study 2, we analyzed pianists' durational and dynamic expressions. According to the functional principal components analyses, we found that the expression of Träumerei consisted of three components: the overall quantity, the cross-sectional contrast between the final and the remaining sections, and the control of the expressive variability. Pianists' expressions were targeted more to the average of the cross-sectional variation in the audience-present than in the audience-absent recordings. In Study 3, we explored a model that explained listeners' responses induced by pianists' acoustical expressions, using path analyses. The final model indicated that the cross-sectional variation of the duration and that of the dynamics determined listeners' evaluations of the quality and the emotionally moving experience, respectively. In line with human's preferences for commonality, the more average the durational expressions were in live recording, the better the listeners' evaluations were regardless of their musical experiences. Only the well-experienced listeners (at least 16 years of musical training were moved more by the deviated dynamic expressions in live recording, suggesting a link between the experienced listener's emotional experience and the unique dynamics in
Monnerie, B; Tavoularis, L G; Guelinckx, I; Hebel, P; Boisvieux, T; Cousin, A; Le Bellego, L
To compare (1) fluid, food and nutrient intake obtained with a paper versus an online version of a 7-day food record and (2) user's acceptability of both versions of the food record. A cross-over study was carried out in 2010 in France. A total of 246 participants aged 18-60 years reported their food and fluid intake using both versions of the 7-day food record, separated by a 7- to 14-day washout period. To help participants in estimating consumed portions, both versions of the food record were supported by a photographic booklet of standard portions and containers. At the end of the study protocol, participants completed a questionnaire designed to assess the acceptability of the two questionnaires. The reported water intake of fluids was significantly higher with the online version compared with the paper version (respectively 1348 ± 36 and 1219 ± 34 mL/day, p < 0.0001). No difference was found between methods in terms of energy intake and the consumption of most food categories, macro- and micronutrients. Furthermore, 77 % of the participants preferred the online method to the paper version. Fluid intake, but not food intake, reported with the online 7-day food record was higher in comparison with the paper version. In addition, the online version was preferred by users. In population surveys, the online record is therefore a relevant alternative, and even a preferred alternative in the case of fluid intake, to the paper record.
A case study of pedometer-recorded steps along the Himalayan mountain range. ... African Journal for Physical Activity and Health Sciences ... The aim of this study was to provide data on the volume and intensity of steps in five healthy adults on an 11-day hike along the Himalayan mountain range and to highlight some ...
Shih, Y.-Y. [Institute of Biomedical Engineering, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei, Taiwan (China); Chen, Y.-Y. [Department of Electrical and Control Engineering, National Chiao-Tung University, Hsinchu, Taiwan (China); Chen, J.-C. [Faculty of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Department of Education and Research, Taipei City Hospital, Taipei, Taiwan (China); Chang Chen [Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan (China); Jaw, F.-S. [Institute of Biomedical Engineering, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei, Taiwan (China)], E-mail: email@example.com
The present study developed an integrated system for use in combined PET, MRI, and electrophysiological recording in somatosensory studies in rats, called ISPMER. A stereotaxic frame was designed for animal positioning that could be used in all three measurement modalities, and its dimensions complied with the gold standard of the Paxinos and Watson rat brain atlas. A graphical user interface was developed for analyzing the data using several signal processing algorithms. This integrated system provides a novel interface for the recording and processing of three-dimensional neuronal signals in three modalities.
Madden, Kim; Tai, Kerry; Ali, Zak; Schneider, Patricia; Singh, Mahip; Ghert, Michelle; Bhandari, Mohit
Registering study protocols in a trial registry is important for methodologic transparency and reducing selective reporting bias. The objective of this investigation was to determine whether published studies of intimate partner violence (IPV) that had been registered matched the registration record on key study design elements. We systematically searched three trial registries to identify registered IPV studies and the published literature for the associated publication. Two authors independently determined for each study whether key study elements in the registry matched those in the published paper. We included 66 studies published between 2006 and 2017. Nearly half (29/66, 44%) were registered after study completion. Many (26/66, 39%) had discrepancies regarding the primary outcome, and nearly two-thirds (42/66, 64%) had discrepancies in secondary outcomes. Discrepancies in study design were less frequent (13/66, 20%). However, large changes in sample size (26/66, 39%) and discrepancies in funding source (28/66, 42%) were frequently observed. Trial registries are important tools for research transparency and identifying and preventing outcome switching and selective outcome reporting bias. Published IPV studies often differ from their records in trial registries. Researchers should pay close attention to the accuracy of trial registry records.
Li, Qinghui; Gu, Donghong; Gan, Fuxi
Monolayer TeOx thin films were deposited on K9 glass substrates or copper grids by vacuum evaporation. Structure of the as-deposited TeOx thin film was determined by TEM and XPS. The TeOx thin film was successfully recorded with a short-wavelength laser beam (514.5 nm). Atomic force microscopy (AFM) is used to study the microstructure of recorded marks. Micro-area morphology images show that the marks are deformed, and depressions and bulges have been imaged in the recorded marks. The level of the deformation is enhanced with the increase of writing power. AFM allows a precise determination of the mark size, the depression depth and the bulge height. The present setup allows the identification of individual marks through a specific location method and the correlation of the reflectivity contast, C, caused by a specific writing power to the morphology of the marks. According to the results of TEM analysis, there was no obvious difference between the phase state of as-deposited film and that of the recorded area. Based on the experimental results, the recording mechanism of TeOx thin film was discussed.
Gromik, Nicolas A.
This paper reports on a case study conducted at a Japanese national university. Nine participants used the video recording feature on their cell phones to produce weekly video productions. The task required that participants produce one 30-second video on a teacher-selected topic. Observations revealed the process of video creation with a cell…
Fouwels, A.J.; Bredie, S.J.H.; Wollersheim, H.C.H.; Schippers, G.M.
BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of the
Fouwels, Annemarie J.; Bredie, Sebastiaan J. H.; Wollersheim, Hub; Schippers, Gerard M.
ABSTRACT: BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of
Dollar, Charles M.
This study is a review of trends in information-handling technology and significant developments which are changing or will change the general environment within which archivists and records managers in international organizations will have to work. Trends in microelectronics, electronic storage, software, data transmission, computer architecture,…
Telegin, A.N.; Bulatov, M.G.
An algorithm is proposed for determining effective velocities in the process of diffraction transformation of seismic waves. It is based on summation with conjugate recordings. Results of the study of velocities are indicated in materials of Sakhalin. A difference is noted in the procedures for computing effective velocities in the OGT method and diffraction transformation.
Roshani, H.; Dabhoiwala, N. F.; tee, S.; Dijkhuis, T.; Kurth, K. H.; Ongerboer de Visser, B. W.; de Jong, J. M.; Lamers, W. H.
Ureteric peristalsis transports a urinary bolus from the renal pelvis to the bladder. We developed an intraluminal catheter with a pressure transducer on it to study intraluminal pressure changes and a twin bipolar electrode to record the ureteric EMG and impedance (Z) changes during a peristaltic
Full Text Available With the accelerated implementation of e-learning systems in educational institutions, it has become possible to record learners’ study logs in recent years. It must be admitted that little research has been conducted upon the analysis of the study logs that are obtained. In addition, there is no software that traces the mouse movements of learners during their learning processes, which the authors believe would enable teachers to better understand their students’ behaviors. The objective of this study is to develop a Web application that records students’ study logs, including their mouse trajectories, and to devise an IR tool that can summarize such diversified data. The results of an experiment are also scrutinized to provide an analysis of the relationship between learners’ activities and their study logs.
Adekunle Yisau Abdulkadir
Full Text Available AIM: With the background knowledge that auditing of Medical Records (MR for adequacy and completeness is necessary if it is to be useful and reliable in continuing patient care; protection of the legal interest of the patient, physicians, and the Hospital; and meeting requirements for researches, we scrutinized theatre records of our hospital to identify routine omissions or deficiencies, and correctable errors in our MR system. METHOD: Obstetrics and Gynaecological post operation theatre records between January 2006 and December 2008 were quantitatively and qualitatively analyzed for details that included: hospital number; Patients age; diagnosis; surgery performed; types and modes of anesthesia; date of surgery; patients ward; Anesthetists names; surgeons and attending nurses names, and abbreviations used with SPSS 15.0 for Windows. RESULTS: Hardly were any of the 1270 surgeries during the study period documented without an omission or an abbreviation. Hospital numbers and patients age were not documented in 21.8% (n=277 and 59.1% (n=750 respectively. Diagnoses and surgeries were recorded with varying abbreviations in about 96% of instances. Surgical team names were mostly abbreviated or initials only given. CONCLUSION: To improve the quality of Paper-based Medical Record, regular auditing, training and good orientation of medical personnel for good record practices, and discouraging large volume record book to reduce paper damages and sheet loss from handling are necessary else what we record toady may neither be useful nor available tomorrow. [TAF Prev Med Bull 2010; 9(5.000: 427-432
Roy, Sabyasachi; Wang, Xiaoqin
The ability to record well-isolated action potentials from individual neurons in naturally behaving animals is crucial for understanding neural mechanisms underlying natural behaviors. Traditional neurophysiology techniques, however, require the animal to be restrained which often restricts natural behavior. An example is the common marmoset (Callithrix jacchus), a highly vocal New World primate species, used in our laboratory to study the neural correlates of vocal production and sensory feedback. When restrained by traditional neurophysiological techniques marmoset vocal behavior is severely inhibited. Tethered recording systems, while proven effective in rodents pose limitations in arboreal animals such as the marmoset that typically roam in a three-dimensional environment. To overcome these obstacles, we have developed a wireless neural recording technique that is capable of collecting single-unit data from chronically implanted multi-electrodes in freely moving marmosets. A lightweight, low power and low noise wireless transmitter (headstage) is attached to a multi-electrode array placed in the premotor cortex of the marmoset. The wireless headstage is capable of transmitting 15 channels of neural data with signal-to-noise ratio (SNR) comparable to a tethered system. To minimize radio-frequency (RF) and electro-magnetic interference (EMI), the experiments were conducted within a custom designed RF/EMI and acoustically shielded chamber. The individual electrodes of the multi-electrode array were periodically advanced to densely sample the cortical layers. We recorded single-unit data over a period of several months from the frontal cortex of two marmosets. These recordings demonstrate the feasibility of using our wireless recording method to study single neuron activity in freely roaming primates. Copyright © 2011 Elsevier B.V. All rights reserved.
Denaxas, Spiros C; George, Julie; Herrett, Emily; Shah, Anoop D; Kalra, Dipak; Hingorani, Aroon D; Kivimaki, Mika; Timmis, Adam D; Smeeth, Liam; Hemingway, Harry
The goal of cardiovascular disease (CVD) research using linked bespoke studies and electronic health records (CALIBER) is to provide evidence to inform health care and public health policy for CVDs across different stages of translation, from discovery, through evaluation in trials to implementation, where linkages to electronic health records provide new scientific opportunities. The initial approach of the CALIBER programme is characterized as follows: (i) Linkages of multiple electronic heath record sources: examples include linkages between the longitudinal primary care data from the Clinical Practice Research Datalink, the national registry of acute coronary syndromes (Myocardial Ischaemia National Audit Project), hospitalization and procedure data from Hospital Episode Statistics and cause-specific mortality and social deprivation data from the Office of National Statistics. Current cohort analyses involve a million people in initially healthy populations and disease registries with ∼105 patients. (ii) Linkages of bespoke investigator-led cohort studies (e.g. UK Biobank) to registry data (e.g. Myocardial Ischaemia National Audit Project), providing new means of ascertaining, validating and phenotyping disease. (iii) A common data model in which routine electronic health record data are made research ready, and sharable, by defining and curating with meta-data >300 variables (categorical, continuous, event) on risk factors, CVDs and non-cardiovascular comorbidities. (iv) Transparency: all CALIBER studies have an analytic protocol registered in the public domain, and data are available (safe haven model) for use subject to approvals. For more information, e-mail firstname.lastname@example.org PMID:23220717
Barr, Paul J; Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn
Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth's Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a
Full Text Available The target of compulsory certification in Information Security Management System has extended to medical institutions. This caused us to recognize the importance of information security in modern hospital information system that has changed from the medical record management that was recorded and managed largely in paper chart in the past to the Electronic Medical Record that medical personnel enter patient information into a computer directly for building a database. As medical institutions manage sensitive information like personal information basically, personal medical data infringement accident, if occurred can become a big social issue. Currently, the medical information in medical institutions are stored in electronic medical records and to access, user authentication is required by means of accredited certificate as security measure. Accredited certification has technical problems such as certificate storage method and security level of password and managerial problems such as certificate copy/leak/share. In this respect, this study proposes and presents how to build the FIDO-based authentication system that applies UAF or U2F authentication mechanism depending on the authority and work scope of medical personnel and medical support assistant like staffs, officers, licensed practical nurse and so on, within large medical institutions that use medical information system. The aim is to solve problems in accredited certificate authentication method in the existing medical institutions with the FIDO-based authentication system proposed in this study.
Prior, Helen; Bottomley, Anna; Champéroux, Pascal; Cordes, Jason; Delpy, Eric; Dybdal, Noel; Edmunds, Nick; Engwall, Mike; Foley, Mike; Hoffmann, Michael; Kaiser, Robert; Meecham, Ken; Milano, Stéphane; Milne, Aileen; Nelson, Rick
Introduction The Safety Pharmacology Society (SPS) and National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs) conducted a survey and workshop in 2015 to define current industry practices relating to housing of non-rodents during telemetry recordings in safety pharmacology and toxicology studies. The aim was to share experiences, canvas opinion on the study procedures/designs that could be used and explore the barriers to social housing. Methods Thirty-nine ...
Medication errors are a major source of preventable morbidity, mortality and cost and many occur at the times of hospital admission and discharge. Novel interventions (such as new methods of recording medication information and conducting medication reconciliation) are required to facilitate accurate transfer of medication information. With existing evidence supporting the use of information technology and the patient representing the one constant in the care process, an electronic patient held medication record may provide a solution. This study will assess the feasibility of introducing a patient held electronic medication record in primary and secondary care using the Consolidated Framework for Implementation Research (CFIR).This feasibility study is a mixed method study of community dwelling older adult patients admitted to an urban secondary care facility comprising a non-randomised intervention and qualitative interviews with key stakeholders. Outcomes of interest include clinical outcomes and process evaluation.This study will yield insights pertaining to feasibility, acceptability and participation for a more definitive evaluation of the intervention. The study also has the potential to contribute to knowledge of implementation of technology in a healthcare context and to the broader area of implementation science.
Poldervaart, Judith M; van Melle, Marije A; Willemse, Sanne; de Wit, Niek J; Zwart, Dorien L M
An increasing number of transitions due to substitution of care of more complex patients urges insight in and improvement of transitional medication safety. While lack of documentation of prescription changes and/or lack of information exchange between settings likely cause adverse drug events, frequency of occurrence of these causes is not clear. Therefore, we aimed at determining the frequency of in-hospital patients’ prescription changes that are not or incorrectly documented in their primary care provider’s (PCP) medical record. A medical record review study was performed in a database linking patients’ medical records of hospital and PCP. A random sample (n = 600) was drawn from all 1399 patients who were registered at a participating primary care practice as well as the gastroenterology or cardiology department in 2013 of the University Medical Center Utrecht, the Netherlands. Outcomes were the number of in-hospital prescription changes that was not or incorrectly documented in the medical record of the PCP, and timeliness of documentation. Records of 390 patients included one or more primary-secondary care transitions; in total we identified 1511 transitions. During these transitions, 408 in-hospital prescription changes were made, of which 31% was not or incorrectly documented in the medical record of the PCP within the next 3 months. In case changes were documented, the median number of days between hospital visit and documentation was 3 (IQR 0–18). One third of in-hospital prescription changes was not or incorrectly documented in the PCP’s record, which likely puts patients at risk of adverse drug events after hospital visits. Such flawed reliability of a routine care process is unacceptable and warrants improvement and close monitoring.
Ann R R Robertson
Full Text Available Background Globally, diabetes mellitus presents a substantial burden to individuals and healthcare systems. Structuring and/or coding of medical records underpin attempts to improve information sharing and searching, potentially bringing clinical and secondary uses benefits.Aims and objectives We investigated if, how and why records for adults with diabetes were structured and/or coded, and explored stakeholders’ perceptions of current practice.Methods We carried out a qualitative, theoretically-informed case study of documenting healthcare information for diabetes patients in family practice and hospital settings, using semi-structured interviews, observations, systems demonstrations and documentary data.Results We conducted 22 interviews and four on-site observations, and reviewed 25 documents. For secondary uses – research, audit, public health and service planning – the benefits of highly structured and coded diabetes data were clearly articulated. Reported clinical benefits in terms of managing and monitoring diabetes, and perhaps encouraging patient self-management, were modest. We observed marked differences in levels of record structuring and/or coding between settings, and found little evidence that these data were being exploited to improve information sharing between them.Conclusions Using high levels of data structuring and coding in medical records for diabetes patients has potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK.
Morrison, Cecily; Jones, Matthew; Blackwell, Alan; Vuylsteke, Alain
Electronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medical record. A qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews. Our analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions. We discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round.
Yong, Paul Zhihao; Lim, Stephen Wee Hun
We investigated the testing effect in Coursera video-based learning. One hundred and twenty-three participants either (a) studied an instructional video-recorded lecture four times, (b) studied the lecture three times and took one recall test, or (c) studied the lecture once and took three tests. They then took a final recall test, either immediately or a week later, through which their learning was assessed. Whereas repeated studying produced better recall performance than did repeated testing when the final test was administered immediately, testing produced better performance when the final test was delayed until a week after. The testing effect was observed using Coursera lectures. Future directions are documented.
Raphael Brandão Pereira
Full Text Available The objective of this study was to analyze the recording of the nursing process, supported by information and communication technologies in both printed and electronic media in the neonatal intensive care scenario. This case study was exclusive, integrated, and conducted between January and April 2014. The study counted on the participation of seven nurses who worked at a neonatal ICU before and after the deployment of new information and communication technologies, which combined electronic and physical (paper support. Data were collected from medical records and a questionnaire answered by the nurses. Simple and percentage frequency in the levels of the nursing process application were used for analysis, as well as the set of intervening factors related to the work organization structure and process. Positive and negative results were seen, as well as intervening factors. The study concluded that the new information and communication technologies delivered in physical materials accounted for the registration of the higher number of records in the data collection and that the registration of the other stages did not show any substantial improvement.
Juarez-Colunga, Elizabeth; Dean, C B; Balshaw, Robert
Many clinical trials are designed to study outcome measures recorded as the number of events occurring during specific intervals, called panel data. In such data, the intervals are specified by a planned set of follow-up times. As the collection of panel data results in a partial loss of information relative to a record of the actual event times, it is important to gain a thorough understanding of the impact of panel study designs on the efficiency of the estimates of treatment effects and covariates. This understanding can then be used as a base from which to formulate appropriate designs by layering in other concerns, e.g. clinical constraints, or other practical considerations. We compare the efficiency of the analysis of panel data with respect to the analysis of data recorded precisely as times of recurrences, and articulate conditions for efficient panel designs where the focus is on estimation of a treatment effect when adjusting for other covariates. We build from the efficiency comparisons to optimize the design of panel follow-up times. We model the recurrent intensity through the common proportional intensity framework, with the treatment effect modeled flexibly as piecewise constant over panels, or groups of panels. We provide some important considerations for the design of efficient panel studies, and illustrate the methods through analysis of designs of studies of adenomas.
Construction of the database system aimed at multipurpose application of data on clinical medicine was studied through the preparation of database system for clinical records of atomic bomb survivors. The present database includes the data about 110,000 atomic bomb survivors in Nagasaki City. This study detailed: (1) Analysis of errors occurring in a period from generation of data in the clinical field to input into the database, and discovery of a highly precise, effective method of input. (2) Development of a multipurpose program for uniform processing of data on physical examinations from many organizations. (3) Development of a record linkage method for voluminous files which are essential in the construction of a large-scale medical information system. (4) A database model suitable for clinical research and a method for designing a segment suitable for physical examination data. (Chiba, N.)
Zivin, Kara; White, Jessica O; Chao, Sandra; Christensen, Anna L; Horner, Luke; Petersen, Dana M; Hobbs, Morgan R; Capreol, Grace; Halbritter, Kevin A; Jones, Christopher M
To pilot test the effectiveness, feasibility, and acceptability of instituting a 15-pill quantity default in the electronic health record for new Schedule II opioid prescriptions. A mixed-methods pilot study in two health systems, including pre-post analysis of prescribed opioid quantity and focus groups or interviews with prescribers and health system administrators. We implemented a 15-pill electronic health record default for new Schedule II opioids and assessed opioid quantity before and after implementation using electronic health record data on 6,390 opioid prescriptions from 448 prescribers. We then analyzed themes from focus groups and interviews with four staff members and six prescribers. The proportion of opioid prescriptions for 15 pills increased at both sites after adding an electronic health record default, with one reaching statistical significance (from 4.1% to 7.2% at CHC, P = 0.280, and 15.9% to 37.2% at WVU, P default, although ease of implementation varied by electronic health record vendor. Most prescribers were not aware of the default change and stated that they made prescribing decisions based on patient clinical characteristics rather than defaults. This pilot provides initial evidence that changing default settings can increase the number of prescriptions at the default level. This low-cost and relatively simple intervention could have an impact on opioid overprescribing. However, default settings should be selected carefully to avoid unintended consequences. © 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: email@example.com
Robertson, Ann R R; Fernando, Bernard; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz
Globally, diabetes mellitus presents a substantial and increasing burden to individuals, health care systems and society. Structuring and coding of information in the electronic health record underpin attempts to improve sharing and searching for information. Digital records for those with long-term conditions are expected to bring direct and secondary uses benefits, and potentially to support patient self-management. We sought to investigate if how and why records for adults with diabetes were structured and coded and to explore a range of UK stakeholders' perceptions of current practice in the National Health Service. We carried out a qualitative, theoretically informed case study of documenting health care information for diabetes in family practice and hospital settings in England, using semi-structured interviews, observations, systems demonstrations and documentary data. We conducted 22 interviews and four on-site observations. With respect to secondary uses - research, audit, public health and service planning - interviewees clearly articulated the benefits of highly structured and coded diabetes data and it was believed that benefits would expand through linkage to other datasets. Direct, more marginal, clinical benefits in terms of managing and monitoring diabetes and perhaps encouraging patient self-management were also reported. We observed marked differences in levels of record structuring and/or coding between family practices, where it was high, and the hospital. We found little evidence that structured and coded data were being exploited to improve information sharing between care settings. Using high levels of data structuring and coding in records for diabetes patients has the potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK. A first step would be for hospitals to attain levels of health information technology infrastructure and systems use commensurate with family practices.
Conclusions Progress toward a problem-oriented EPR system based on episodes of care that includes decision support is necessary to satisfy the needs expressed by GPs. Further research could solve the problem of integration of functionality for consultation with specialists and integration with patient held records. Results from this study could contribute to further development of the next generation of EPRs in primary care, as well as inspire the application of EPRs in other parts of the health sector.
Jorge J. Cherem
Full Text Available Studies to evaluate environmental impacts have become both a need and a requirement of environmental agencies due to great alteration of the native environments provoked by man. Many of these studies are short-termed, but reporting the acquired data is very important in order to increase knowledge about specific biotic groups. Thus, this paper presents the results of the non-volant mammal surveys arising from seven environmental studies in southern Brazil. The following methodologies were employed: (1 interviews with local residents; (2 visual observations and recording; (3 identification of vestiges; and (4 capture with live traps. A total of 46 mammal species were recorded (5 marsupials, 4 xenarthrans, 2 primates, 13 carnivores, 2 artiodactylans, 2 lagomorphs and 18 rodents. Some species, such as the jaguar (Panthera onca, giant otter (Pteronura brasiliensis, Brazilian tapir (Tapirus terrestris and white-lipped peccary (Tayassu pecari, are possibly extinct or seriously threatened. The records obtained and the possibilities of the occurrence of other species are discussed.
Robie, D.M.; Fry, S.A.
The availability of computers with increasing capabilities has made feasibile epidemiologic studies involving large populations such as those utilized to evaluate the health effects of occupational exposure to radiation. However, the storage and retrieval of data from the large numbers of hard-copy personnel, health physics, employment medical, historical or anecdotal documents that are the bases of such studies pose major logistics problems to investigators. The potential value of such records to epidemiologic studies depends, not only on their accuracy and completeness, but also on ease of accessibility. To address the latter problem, we are using a stand-alone user-oriented electronic filing system that records, stores, and secures hard-copy documents micrographically. This system is controlled by a computer that provides retrieval of a document image and printed copy (if desired) in less than 30 seconds from a maximum of eight fields. One thousand documents are randomly filmed and indexed on computer storage diskettes in two hours. Manual sorting and filing of the same number of documents takes over a day. At present two thousand documents can be recorded on each microfilm roll and 85,000 documents indexed on each diskette. Simultaneous searching for documents can be done using up to ten terminals while indexing is being done at the main terminal. The micrographics system provides the space-saving and security advantages of microfilm with the speed of computerized data retrieval
Full Text Available As a part of pre-implementation of Electronic Health Record (EHR as communicating tool, the study aims at investigating the awareness, perception, and usability of EHR among nurses working in 2032 bedded hospital in southern India. A cross sectional descriptive study with convenient sampling method of 296 nurses was used. The validated questionnaire contained questions related to perception of the nurses about the existing system of record keeping and their effect on patient care; Usefulness of EMR for their practice; relative important of features of EMR; acceptance level and training needs. For analysis SPSS 10.0 version was used. The results of this study is promising in terms of nurses’ views for adoption of EHR. Also, suggests, nurses are beginning to perceive benefits in areas of quality in decision making; patient care and practice; enhance timely access to medical records; efficiency; productivity. Strategies are needed for improving the EHR knowledge among nurses who have a negative perception of and attitude towards it.
Benevento, L A; Port, J D
The nonretinotopic portion of the macaque pulvinar complex is interconnected with the occipitoparietal and occipitotemporal transcortical visual systems where information about the location and motion of a visual object or its form and color are modulated by eye movements and attention. We recorded from single cells in and about the border of the dorsal portion of the lateral pulvinar and the adjacent medial pulvinar of awake behaving Macaca mulatta in order to determine how the properties of these two functionally dichotomous cortical systems were represented. We found a class of pulvinar neurons that responded differentially to ten different patterns or broadband wavelengths (colors). Thirty-four percent of cells tested responded to the presentation of at least one of the pattern or color stimuli. These cells often discharged to several of the patterns or colors, but responded best to only one or two of them, and 86% were found to have statistically significant pattern and/or color preferences. Pattern/color preferential cells had an average latency of 79.1 +/- 46.0 ms (range 31-186 ms), responding well before most inferotemporal cortical cell responses. Visually guided and memory-guided saccade tasks showed that 58% of pattern/color preferential cells also had saccade-related properties, e.g. directional presaccadic and postsaccadic discharges, and inhibition of activity during the saccade. In the pulvinar, the mean presacadic response latency was earlier, and the mean postsaccadic response latency was later, than those reported for parietal cortex. We also discovered that the strength of response to patterns or colors changed depending upon the behavioral setting. In comparison to trials in which the monkey fixated dead ahead during passive presentations of pattern and color stimuli, 92% of the cells showed attenuated responses to the same passive presentation of patterns and colors during fixation when these trials were interleaved with trials which also
National Oceanic and Atmospheric Administration, Department of Commerce — Phenology is the scientific study of periodic biological phenomena, such as flowering, breeding, and migration, in relation to climatic conditions. The few records...
Seminog, Olena O; Seminog, Alla B; Yeates, David; Goldacre, Michael J
There are reports suggesting that people with Klinefelter's syndrome (KS) may be at increased risk of some autoimmune diseases, but the evidence is not substantial. We wanted to add to the evidence by systematically assessing the risk of autoimmune diseases in a national cohort of people with KS. We selected records of all people with KS in a record-linked dataset of all hospital day cases and inpatient admissions in England, 1999-2011; and we followed them up by electronic record linkage to identify the occurrence of autoimmune diseases. We compared their occurrence in the KS cohort with a control cohort, studied in the same way, and expressed the results as rate ratios (RR). Of 30 autoimmune diseases studied in people with KS, there were significantly increased risks of seven-Addison's disease (RR 11.7, 95% confidence interval 2.4-34.4), diabetes mellitus type 1 (6.1, 4.4-8.3), multiple sclerosis (4.3, 1.2-11.0), acquired hypothyroidism (2.7, 1.8-4.0), rheumatoid arthritis (3.3, 2.0-5.2), Sjogren's syndrome (19.3, 4.0-57.0) and systemic lupus erythematosus (18.1, 2.2-65.6). We concluded that people with KS have increased risk of some autoimmune diseases, particularly those that are female-predominant. The increased risk of autoimmune diseases associated with the XXY karyotype may hold clues to the pathogenesis of some aspects of autoimmunity.
Gallo, Erika Alejandra Giraldo; Menezes, Ana Maria B; Murray, Joseph; Silva, Luciana Anselmi Duarte da; Wehrmeister, Fernando César; Gonçalves, Helen; Barros, Fernando
This article describes different types of officially recorded victimization among 5,249 children in the 1993 birth cohort in the city of Pelotas, Rio Grande do Sul State, Brazil. Official data were obtained from the Secretariat for Public Security and the Special Court for Children and Youth. Victimization was registered for in 1,150 cohort members, with 1,396 incidents recorded as of December 31, 2012. The total incidence of victimization was 15.7 ocorrences per 1,000 person-years, with the majority involving violent victimization (12.7 per 1,000 person-years). Victimization increased gradually in childhood and rapidly throughout adolescence. The highest incidence rates were among females (p crimes against personal freedom; non-violent victimization mainly involved theft. Studies like this help identify lifetime risk and protective factors for victimization, highlighting the importance of surveillance and control measures against violence.
Bower, Julie K; Bollinger, Claire E; Foraker, Randi E; Hood, Darryl B; Shoben, Abigail B; Lai, Albert M
With the growing use of electronic medical records, electronic health records (EHRs), and personal health records (PHRs) for health care delivery, new opportunities have arisen for population health researchers. Our objective was to characterize PHR users and examine sample representativeness and nonresponse bias in a study of pregnant women recruited via the PHR. Demographic characteristics were examined for PHR users and nonusers. Enrolled study participants (responders, n=187) were then compared with nonresponders and a representative sample of the target population. PHR patient portal users (34 percent of eligible persons) were older and more likely to be White, have private health insurance, and develop gestational diabetes than nonusers. Of eligible persons (all PHR users), 11 percent (187/1,713) completed a self-administered PHR based questionnaire. Participants in the research study were more likely to be non-Hispanic White (90 percent versus 79 percent) and married (85 percent versus 77 percent), and were less likely to be Non-Hispanic Black (3 percent versus 12 percent) or Hispanic (3 percent versus 6 percent). Responders and nonresponders were similar regarding age distribution, employment status, and health insurance status. Demographic characteristics were similar between responders and nonresponders. Demographic characteristics of the study population differed from the general population, consistent with patterns seen in traditional population-based studies. The PHR may be an efficient method for recruiting and conducting observational research with additional benefits of efficiency and cost-cost-effectiveness.
Full Text Available Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3 but not in either of the controls (−2.0 to −0.3%. The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2 and 33.7% (26.6–41.3. The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.
Zheng, Kai; Padman, Rema; Krackhardt, David; Johnson, Michael P; Diamond, Herbert S
To study how social interactions influence physician adoption of an electronic health records (EHR) system. A social network survey was used to delineate the structure of social interactions among 40 residents and 15 attending physicians in an ambulatory primary care practice. Social network analysis was then applied to relate the interaction structures to individual physicians' utilization rates of an EHR system. The social network survey assessed three distinct types of interaction structures: professional network based on consultation on patient care-related matters; friendship network based on personal intimacy; and perceived influence network based on a person's perception of how other people have affected her intention to adopt the EHR system. EHR utilization rates were measured as the proportion of patient visits in which sentinel use events consisting of patient data documentation or retrieval activities were recorded. The usage data were collected over a time period of 14 months from computer-recorded audit trail logs. Neither the professional nor the perceived influence network is correlated with EHR usage. The structure of the friendship network significantly influenced individual physicians' adoption of the EHR system. Residents who occupied similar social positions in the friendship network shared similar EHR utilization rates (psocially similar' residents were attending physicians (pSocial influence affecting physician adoption of EHR seems to be predominantly conveyed through interactions with personal friends rather than interactions in professional settings.
Flørenes, T W; Nordsletten, L; Heir, S; Bahr, R
No long-term injury surveillance programs exist for competitive skiing or snowboarding. The objective of this study was, therefore, to compare different methods to record injuries among World Cup athletes in alpine, freestyle, and cross-country skiing, snowboarding, ski jumping and Nordic combined. Information regarding injuries sustained during the 2006-2007 winter season was recorded through three separate and independent systems: prospective injury reports by technical delegates (TD) from the International Ski Federation, prospective medical team registration by selected teams, and retrospective athlete interviews at the end of the season. A total of 100 unique injuries to 602 World Cup athletes were identified from any of the three recording methods. Of these, 91% were registered through the athlete interviews, 47% by the medical team registration and 27% by the TD reports. Only 20 injuries (20%) were captured by all three methods. A total of 64 time-loss injuries were registered. The interviews captured 60 (94%), the medical team registration 39 (61%), and the TD reports 23 (36%) time-loss injuries, while 18 (28%) were registered by all three systems. Retrospective interviews with athletes/coaches regarding injuries during the last 6 months gave the most complete picture of injuries to World Cup skiers and snowboarders. © 2009 John Wiley & Sons A/S.
Onabolu, Olanrewaju; Donos, Nikos; Tu, Yu-Kang; Darbar, Ulpee; Nibali, Luigi
The current classification assumes that aggressive periodontitis (AgP) has a faster rate of progression than chronic periodontitis (CP). However, this has not been clearly proven and difficulties exist in establishing progression. This study aimed to assess the feasibility of retrospectively utilising previous records for clinical diagnosis of periodontal diseases and to assess if two different patterns of disease progression exist between AgP and CP. Previous radiographic records of a cohort of 235 patients clinically diagnosed with AgP or CP were requested from the referring general dental practitioners (GDPs). Comparable radiographic records were analysed in order to assess progression patterns and associate these with clinical diagnosis, by multilevel analysis. 43 patients out of the initial 235 had comparable radiographs retrieved from the GDPs. 858 sites were followed for an average 6.6 years. Radiographically, AgP showed a faster linear pattern of progression than CP (0.31mm/year vs. 0.20mm/year, pperiodontal disease progression and may have an impact on the clinical management of aggressive periodontitis, since our findings show that there is continuous destruction in patients with aggressive periodontitis if left untreated. Copyright © 2015 Elsevier Ltd. All rights reserved.
Bouamrane, Matt-Mouley; Mair, Frances S
Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors.
Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris
The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a
Wagner, Abram L; Zhang, Ying; Montgomery, JoLynn P; Ding, Yaxing; Carlson, Bradley F; Boulton, Matthew L
Measles is a highly infectious disease, and timely administration of two doses of vaccine can ensure adequate protection against measles for all ages in a population. This study aims to estimate the proportion of children aged 8 months to 6 years vaccinated on time with measles-containing vaccines (MCV) and vaccinated during the 2008 and 2010 measles supplementary immunization activities. This study also characterizes differences in mean age at vaccination and vaccination timeliness by demographic characteristics, and describes maternal knowledge of measles vaccination. Immunization records were selected from a convenience sample of immunization clinics in Tianjin, China. From the records, overall vaccination coverage and timely vaccination coverage were calculated for different demographic groups. Mothers were also interviewed at these clinics to ascertain their knowledge of measles vaccination. Within the 329 immunization clinic records, child's birth year and district of residence were found to be significant predictors of different measures of vaccine timeliness. Children born in 2009 had a lower age at MCV dose 2 administration (17.96 months) than children born in 2005 (22.00 months). Children living in Hebei, a district in the urban center of Tianjin were less likely to be vaccinated late than children living in districts further from the urban core of Tianjin. From the 31 interviews with mothers, most women believed that timely vaccination was very important and more than one dose was very necessary; most did not know whether their child needed another dose. When reviewing MCV coverage in China, most studies do not consider timeliness. However, this study shows that overall vaccination coverage can greatly overestimate vaccination coverage within certain segments of the population, such as young infants.
Full Text Available OBJECTIVES: To determine variation over time and between practices in recording of concerns related to abuse and neglect (maltreatment in children's primary care records. DESIGN: Retrospective cohort study using a United Kingdom representative primary care database. SETTING: 448 General Practices. PARTICIPANTS: In total 1,548, 972 children (<18 y registered between 1995 and 2010. MAIN OUTCOME MEASURES: Change in annual incidence of one or more maltreatment-related codes per child year of registration. Variation between general practices measured as the proportion of registered children with one or more maltreatment-related codes during 3 years (2008-2010. RESULTS: From 1995-2010, annual incidence rates of any coded maltreatment-related concerns rose by 10.8% each year (95% confidence interval 10.5, 11.2; adjusted for sex, age and deprivation. In 2010 the rate was 9.5 per 1000 child years (95%CI: 9.3, 9.8, equivalent to a prevalence of 0.8% of all registered children in 2010. Across all practices, the median prevalence of children with any maltreatment-related codes in three years (2008 to 2010 was 0.9% (range 0%-13.4%; 11 practices (2.5% had zero children with relevant codes in the same period. Once we accounted for sex, age, and deprivation, the prevalence for each practice was within two standard errors of the grand mean. CONCLUSIONS: General Practitioners (GPs are far from disengaged from safeguarding children; they are consistently and increasingly recording maltreatment concerns. As these results are likely to underestimate the burden of maltreatment known to primary care, there is much scope for increasing recording in primary care records with implications for resources to respond to concerns about maltreatment. Interventions and policies should build on this evidence that the average GP in the UK is engaged in child safeguarding activity.
Farzandipour, Mehrdad; Jeddi, Fateme Rangraz; Gilasi, Hamid Reza; Shirzadi, Diana
infertility is referred to the person's inability to conceive pregnancy after one year of intercourse without using protection. This study paves the ground for creating a complete, united, and coherent source of patients' medical information. this is an applied research of descriptive-cross sectional type which has been carried out through qualitative - quantitative methods. The sample of the present study was 50 specialists in the field of infertility which has been chosen based on purposive sampling method. Designing the questionnaire was done based on library studies and Gathering experts' views was done based on Delphi technique. 261 items from clinical and Para clinical information of infertile patients' electronic health records were subjected to an opinion poll by experts. During this process 223 items were accepted and 38 items have been rejected after two sessions of surveys by infertility experts. Para clinical information section consisted of 57 items that all of them have been accepted by the experts. Also, clinical information section consisted of 242 items from which 204 items were accepted and 38 items were rejected by the experts. existence of a structured electronic record system of infertile patients' information leads to the integration of patients' information, improvement of health care services and a decrease in treatment costs: all working to increase information safety. Furthermore, only essential and relevant information would be provided for the specialists and it will facilitate and direct the future infertility related studies due to the coherence, unity and relevance of the information.
Full Text Available The cerebellum input stage has been known to perform combinatorial operations on input signals. In this paper, two types of mathematical models were used to reproduce the role of feed-forward inhibition and computation in the granular layer microcircuitry to investigate spike train processing. A simple spiking model and a biophysically-detailed model of the network were used to study signal recoding in the granular layer and to test observations like center-surround organization and time-window hypothesis in addition to effects of induced plasticity. Simulations suggest that simple neuron models may be used to abstract timing phenomenon in large networks, however detailed models were needed to reconstruct population coding via evoked local field potentials (LFP and for simulating changes in synaptic plasticity. Our results also indicated that spatio-temporal code of the granular network is mainly controlled by the feed-forward inhibition from the Golgi cell synapses. Spike amplitude and total number of spikes were modulated by LTP and LTD. Reconstructing granular layer evoked-LFP suggests that granular layer propagates the nonlinearities of individual neurons. Simulations indicate that granular layer network operates a robust population code for a wide range of intervals, controlled by the Golgi cell inhibition and is regulated by the post-synaptic excitability.
Chandrasekaran, S.; Supnithi, P.; Warisarn, C.; Bai, D.
Shingled magnetic recording (SMR) has been predicted as one of the novel technologies to extend the areal density beyond 1 Tb/in2. It was widely thought by many researchers that very wide writers could be used for SMR, as it involves corner writing and thus writability would no longer be an issue in SMR. However, in our experimental study, we reveal that there exists an optimal write width for a given writer design due to the erase band limitations. Also we propose the optimal write width for a given shingle track pitch condition.
Glicksberg, Benjamin S; Johnson, Kipp W; Dudley, Joel T
Precision medicine can utilize new techniques in order to more effectively translate research findings into clinical practice. In this article, we first explore the limitations of traditional study designs, which stem from (to name a few): massive cost for the assembly of large patient cohorts; non-representative patient data; and the astounding complexity of human biology. Second, we propose that harnessing electronic health records and mobile device biometrics coupled to longitudinal data may prove to be a solution to many of these problems by capturing a "real world" phenotype. We envision that future biomedical research utilizing more precise approaches to patient care will utilize continuous and longitudinal data sources.
Paul Zhihao eYONG
Full Text Available We investigated the testing effect in Coursera video-based learning. One hundred and twenty-three participants either (a studied an instructional video-recorded lecture four times, (b studied the lecture three times and took one recall test, or (c studied the lecture once and took three tests. They then took a final recall test, either immediately or a week later, through which their learning was assessed. Whereas repeated studying produced better recall performance than did repeated testing when the final test was administered immediately, testing produced better performance when the final test was delayed until a week after. The testing effect was observed using Coursera lectures. Future directions are documented.
Karnes, Jason H; Cronin, Robert M; Rollin, Jerome
. Here, we performed a genome-wide association study (GWAS) and candidate gene study using HIT cases and controls identified using electronic medical records (EMRs) coupled to a DNA biobank and attempted to replicate GWAS associations in an independent cohort. We subsequently investigated influences......-heparin treated patients (OR 3.09; 1.14-8.13; p=0.02). In the candidate gene study, SNPs at HLA-DRA were nominally associated with HIT (OR 0.25; 0.15-0.44; p=2.06×10(-6)). Further study of TDAG8 and HLA-DRA SNPs is warranted to assess their influence on the risk of developing HIT....
Jaarsveld, C.H.M. van; Gulliford, M.C.
OBJECTIVE: This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. DESIGN: Cohort study of primary care electronic health records. SETTING: 375 general
Savica, R; Carlin, J M; Grossardt, B R; Bower, J H; Ahlskog, J E; Maraganore, D M; Bharucha, A E; Rocca, W A
Parkinson disease (PD) may affect the autonomic nervous system and may cause constipation; however, few studies have explored constipation preceding the motor onset of PD. We investigated constipation preceding PD using a case-control study design in a population-based sample. Using the medical records-linkage system of the Rochester Epidemiology Project, we identified 196 subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (+/-1 year) and sex to a general population control. We reviewed the complete medical records of cases and controls in the medical records-linkage system to ascertain the occurrence of constipation preceding the onset of PD (or index year). Constipation preceding PD or the index year was more common in cases than in controls (odds ratio [OR] 2.48; 95% confidence interval [CI] 1.49 to 4.11; p = 0.0005). This association remained significant after adjusting for smoking and coffee consumption (ever vs never), and after excluding constipation possibly induced by drugs. In addition, the association remained significant in analyses restricted to constipation documented 20 or more years before the onset of motor symptoms of PD. Although the association was stronger in women than in men and in patients with PD with rest tremor compared with patients with PD without rest tremor, these differences were not significant. Our findings suggest that constipation occurring as early as 20 or more years before the onset of motor symptoms is associated with an increased risk of Parkinson disease.
Martinez-Laguna, Daniel; Soria-Castro, Alberto; Carbonell-Abella, Cristina; Orozco-López, Pilar; Estrada-Laza, Pilar; Nogues, Xavier; Díez-Perez, Adolfo; Prieto-Alhambra, Daniel
Electronic medical records databases use pre-specified lists of diagnostic codes to identify fractures. These codes, however, are not specific enough to disentangle traumatic from fragility-related fractures. We report on the proportion of fragility fractures identified in a random sample of coded fractures in SIDIAP. Patients≥50 years old with any fracture recorded in 2012 (as per pre-specified ICD-10 codes) and alive at the time of recruitment were eligible for this retrospective observational study in 6 primary care centres contributing to the SIDIAP database (www.sidiap.org). Those with previous fracture/s, non-responders, and those with dementia or a serious psychiatric disease were excluded. Data on fracture type (traumatic vs fragility), skeletal site, and basic patient characteristics were collected. Of 491/616 (79.7%) patients with a registered fracture in 2012 who were contacted, 331 (349 fractures) were included. The most common fractures were forearm (82), ribs (38), and humerus (32), and 225/349 (64.5%) were fragility fractures, with higher proportions for classic osteoporotic sites: hip, 91.7%; spine, 87.7%; and major fractures, 80.5%. This proportion was higher in women, the elderly, and patients with a previously coded diagnosis of osteoporosis. More than 4 in 5 major fractures recorded in SIDIAP are due to fragility (non-traumatic), with higher proportions for hip (92%) and vertebral (88%) fracture, and a lower proportion for fractures other than major ones. Our data support the validity of SIDIAP for the study of the epidemiology of osteoporotic fractures. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Kalfayan, S. H.; Silver, R. H.; Hoffman, J. K.
Methods were developed to determine the coefficient of friction and the extent of stick-slip of magnetic recording tapes. After a preliminary phase during which experimental procedures were established and screening of candidate tapes was carried out, the frictional and stick-slip behavior of four selected tapes, using four different kinds of magnetic heads, was studied at various temperatures, under dry and humid conditions, and in various gaseous atmospheres, such as argon, helium, nitrogen and air. The effects of tape speed and outgassing on the drag properties of the tapes were also studied. A rank was assigned to each tape and magnetic head as a result of these tests. This study helped in the selection of a magnetic tape in a flight project, and will be useful in the consideration of tapes and magnetic heads for future spacecraft applications.
Lynn, W. D.; Escalona, O. J.; McEneaney, D. J.
This study addresses an important question in the development of a ECG device that enables long term monitoring of cardiac rhythm. This device would utilise edge sensor technologies for dry, non-irritant skin contact suitable for distal limb application and would be supported by embedded ECG denoising processes. Contemporary ECG databases including those provided by MIT-BIH and Physionet are focused on interpretation of cardiac disease and rhythm tracking. The data is recorded using chest leads as in standard clinical practise. For the development of a peripherally located heart rhythm monitor, such data would be of limited use. To provide a useful database adequate for the development of the above mentioned cardiac monitoring device a unipolar body surface potential map from the left arm and wrist was gathered in 37 volunteer patients and characterized in this study. For this, the reference electrode was placed at the wrist. Bipolar far-field electrogram leads were derived and analysed. Factors such as skin variability, 50Hz noise interference, electrode contact noise, motion artifacts and electromyographic noise, presented a challenge. The objective was quantify the signal-to-noise ratio (SNR) at the far-field locations. Preliminary results reveal that an electrogram indicative of the QRS complex can be recorded on the distal portion of the left arm when denoised using signal averaging techniques.
Full Text Available Frontal lobe epilepsies may present difficulties in focus localization in the pre-operative work-up for epilepsy surgery. This is specially true in patients with normal MRIs. We report on a 16 years-old girl that started with seizures by the age of 8 years. They were brief nocturnal episodes with automatisms such as bicycling and boxing. Seizure frequency ranged from 4-10 per night. Scalp EEG showed few right frontal convexity spiking and intense secondary bilateral syncrhony (SBS. High resolution MRI directed to the frontal lobes was normal. Ictal SPECT suggested a right fronto-lateral focus. Ictal video-EEG showed no focal onset. She was submitted to invasive recordings after subdural plates implantation. Electrodes covered all the frontal convexity and mesial surface bilaterally. Ictal recordings disclosed stereotyped seizures starting from the right mesial frontal. Using a high-resolution tool to measure intra and interhemispheric latencies, the timing and direction of seizure spread from the right fronto-mesial region were studied. Motor strip mapping was performed by means of electrical stimulation. She was submitted to a right frontal lobe resection, 1.5 cm ahead of the motor strip and has been seizure free since surgery (8 months. Pathological examination found a 4 mm area of cortical dysplasia. Invasive studies are needed to allow adequate localization in patients with non-localizatory non-invasive work-up and may lead to excellent results in relation to seizures after surgery.
Miah, Shah Jahan; Samsudin, Ahmad Zam Hariro
Higher education institutes such as universities suffer from a range of issues in managing their academic records and relevant digital contents. Many universities nowadays use specific software applications for their effective mechanism in records management. The effective provision of enterprises records management (ERM) software for managing…
Dumay, A.C.M.; Haaker, T.I.
Background: A locum practitioner is an out-of-hours general practitioner who needs access to the electronic health record of visiting patients. The electronic locum record is a summary of the electronic health record available to the locum practitioner and includes the most significant health
The purpose of this guide is to describe each series of records that pertains to the epidemiologic studies conducted by the Epidemiology Section of the Occupational Medicine Group (ESH-2) at the Department of Energy`s (DOE) Los Alamos National Laboratory (LANL) in Los Alamos, New Mexico. The records described in this guide relate to occupational studies performed by the Epidemiology Section, including those pertaining to workers at LANL, Mound Plant, Oak Ridge Reservation, Pantex Plant, Rocky Flats Plant, and Savannah River Site. Also included are descriptions of other health-related records generated or collected by the Epidemiology Section and a small set of records collected by the Industrial Hygiene and Safety Group. This guide is not designed to describe the universe of records generated by LANL which may be used for epidemiologic studies of the LANL work force. History Associates Incorporated (HAI) prepared this guide as part of its work as the support services contractor for DOE`s Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI`s role in the project, the history of LANL the history and functions of LANL`s Health Division and Epidemiology Section, and the various epidemiologic studies performed by the Epidemiology Section. It provides information on the methodology that HAI used to inventory and describe records housed in the offices of the LANL Epidemiology Section in Technical Area 59 and at the LANL Records Center. Other topics include the methodology used to produce the guide, the arrangement of the detailed record series descriptions, and information concerning access to records repositories.
Buschbacher, Ralph Michael; Weir, Susan Karolyi; Bentley, John Greg; Cottrell, Erika
Proximal peripheral nerve conduction studies can provide useful information to the clinician. The difficulty of measuring the length of the proximal nerve as well as a frequent inability to stimulate at 2 points along the nerve adds a challenge to the use of electrodiagnosis for this purpose. The purpose of this article is to present normal values for the suprascapular, axillary, and musculocutaneous nerves using surface electrodes while accounting for side-to-side variability. Prospective, observational study. Patients were evaluated in outpatient, private practices affiliated with tertiary care systems in the United States and Malaysia. One hundred volunteers were recruited and completed bilateral testing. Exclusion criteria included age younger than 18 years; previous shoulder surgery/atrophy; symptoms of numbness, tingling, or abnormal sensations in the upper extremity; peripheral neuropathy; or presence of a cardiac pacemaker. Nerve conduction studies to bilateral supraspinatus, infraspinatus, deltoid, and biceps brachii muscles were performed with documented technique. Distal latency, amplitude, and area were recorded. Side-to-side comparisons were made. A mixed linear model was fit to the independent variables of gender, race, body mass index, height, and age with each recorded value. Distal latency, amplitude, area, and side-to-side variability of nerve conduction studies of the suprascapular, axillary, and musculocutaneous nerves with correlation to significant independent variables. Data are presented showing normal distal latency, amplitude, and area values subcategorized by clinically significant variables, as well as acceptable side-to-side variability. Increased height correlated with increased distal latency in all the nerves tested. Amplitudes were larger in the infraspinatus recordings from women, while the amplitudes from the biceps and deltoid were greater in men. A larger body mass index was associated with a smaller amplitude in the deltoid in
Paris, Raphaël; Wassmer, Patrick; Lavigne, Franck; Belousov, Alexander; Belousova, Marina; Iskandarsyah, Yan; Benbakkar, Mhammed; Ontowirjo, Budianto; Mazzoni, Nelly
The well-documented 1883 eruption of Krakatau volcano (Indonesia) offers an opportunity to couple the eruption's history with the tsunami record. The aim of this paper is not to re-analyse the scenario for the 1883 eruption but to demonstrate that the study of tsunami deposits provides information for reconstructing past eruptions. Indeed, though the characteristics of volcanogenic tsunami deposits are similar to those of other tsunami deposits, they may include juvenile material (e.g. fresh pumice) or be interbedded with distal pyroclastic deposits (ash fall, surges), due to their simultaneity with the eruption. Five kinds of sedimentary and volcanic facies related to the 1883 events were identified along the coasts of Java and Sumatra: (1) bioclastic tsunami sands and (2) pumiceous tsunami sands, deposited respectively before and during the Plinian phase (26-27 August); (3) rounded pumice lapilli reworked by tsunami; (4) pumiceous ash fall deposits and (5) pyroclastic surge deposits (only in Sumatra). The stratigraphic record on the coasts of Java and Sumatra, which agrees particularly well with observations of the 1883 events, is tentatively linked to the proximal stratigraphy of the eruption.
Full Text Available Microbialites are sedimentary formations that are found throughout the geological record and are usually considered as one of the oldest traces of life on Earth. Although they have been known for more than a century and hold as an emblematic object in Earth Sciences, we yet do not understand in details how they form and how microbial processes impact their chemistry, structure and macroscopic morphology. Here, we show recent advances achieved owing to funding provided by the EPOV program on the formation of modern microbialites in the crater Lake Alchichica (Mexico. We first show that very diverse microbial communities populate these microbialites, including diverse microbial groups able to induce carbonate precipitation. We demonstrate that this microbial diversity can be preserved for several years in laboratory aquaria offering a nice opportunity for future studies to assess the relationships between biodiversity and microbialite formation. We then detail the textural modifications affecting cyanobacterial cells during the first steps of fossilization as captured in Alchichica microbialites. Finally, we report the discovery of a new deepbranching cyanobacterium species, Candidatus Gloeomargarita lithophora, able to form intracellular Ca-, Mg-, Sr- and Ba-rich carbonates and discuss the implications for the interpretation of the fossil record.
Olsen, Jesper; John Anderson, N.; Leng, M.J.
Stable isotope records are increasingly being used in palaeoenvironmental studies of Arctic lakes. Here we compare stable isotope and elemental records (δ13C, δ15N, C/N) with high resolution XRF-derived geochemical and colour data from low Arctic lakes (SS1220 and SS85) in southwest Greenland. Lake...
McGonagle, Katherine A.; Brown, Charles; Schoeni, Robert F.
Recording interviews is a key feature of quality control protocols for most survey organizations. We examine the effects on interview length and data quality of a new protocol adopted by a national panel study. The protocol recorded a randomly chosen one-third of all interviews digitally, although all respondents were asked for permission to…
Steel, B. A.; Kucera, M.; Darling, K.
Criticism of molecular clock studies often centres on inadequate calibration and a perceived lack of correlation between reproductive isolation and recognisable morphological evolution. Since many major groups (e.g. birds, mammals, reptiles) have a poor fossil record, it is often difficult to test and refute these limitations. Planktic foraminifera represent an exception to this rule. Deep-sea sediments are super-abundant in foraminifera, and large numbers of specimens and occurrences are easily garnered from Ocean Drilling Programme cores. Planktic foraminifera therefore represent an ideal model group with which to test and refine molecular clock studies. Since the 1990AƒAøAøâ_sA¬Aøâ_zAøs, genetic sequences (principally 18S r-RNA) have been extracted from living planktic foraminifera, and a large genetic library has developed. Our study attempts to contextualise and test molecular data, particularly AƒAøAøâ_sA¬Asmall amount of morphological evolution observed within the plexus. We have used morphometric methods on a large (over 2000 pooled specimens) dataset in an effort to independently test the molecular clock, using SEM-based measurement of pore metrics (for Gl. siphonifera) and a multivariate analysis of whole-test characteristics (for Gs. ruber). Comparison of results for the two species suggests interesting patterns; whilst the two cryptic sub-types of Gl. siphonifera seemingly can be traced through time and seem to respond to external oceanographic forcing, the sub-types of Gs. ruber appear to be truly cryptic, and cannot be distinguished in the fossil record beyond 0.7 Ma. This raises two important points; firstly, the molecular clock (at least for foraminifera) bears considerable scrutiny, appears to be relatively robust to substitution bias and is seemingly broadly in accordance with morphological data; and secondly, the relationship between form and function in planktic foraminifera appears to be ill-defined, raising important questions for
Greenhalgh, Trisha; Stramer, Katja; Bratan, Tanja; Byrne, Emma; Mohammad, Yara; Russell, Jill
To explore the introduction of a centrally stored, shared electronic patient record (the summary care record (SCR)) in England and draw wider lessons about the implementation of large scale information technology projects in health care. Multi-site, mixed method case study applying utilisation focused evaluation. Four early adopter sites for the SCR in England-three in urban areas of relative socioeconomic deprivation and the fourth in a relatively affluent rural area. Data sources and analysis Data included 250 staff interviews, 1500 hours of ethnographic observation, interviews and focus groups with 170 patients and carers, 2500 pages of correspondence and documentary evidence, and incorporation of relevant surveys and statistics produced by others. These were analysed by using a thematic approach drawing on (and extending) a theoretical model of complex change developed in a previous systematic review. Main findings The mixed fortunes of the SCR programme in its first year were largely explained by eight interacting influences. The first was the SCR's material properties (especially technical immaturity and lack of interoperability) and attributes (especially the extent to which potential adopters believed the benefits outweighed the risks). The second was adopters' concerns (especially about workload and the ethicality of sharing "confidential" information on an implied consent model). The third influence was interpersonal influence (for example, opinion leaders, champions, facilitators), and the fourth was organisational antecedents for innovation (for example past experience with information technology projects, leadership and management capacity, effective data capture systems, slack resources). The fifth was organisational readiness for the SCR (for example, innovation-system fit, tension for change, power balances between supporters and opponents, baseline data quality). The sixth was the implementation process (including the nature of the change model and
Full Text Available Ye-Seul Lee,1 Won-Mo Jung,1 Hyunchul Jang,2 Sanghyun Kim,2 Sun-Yong Chung,3 Younbyoung Chae1 1Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, 2Mibyeong Research Center, Korean Institute of Oriental Medicine, Daejeon, 3Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea Objectives: Recently, there has been increasing interest in preventing and managing diseases both inside and outside medical institutions, and these concerns have supported the development of the individual Personal Health Record (PHR. Thus, the current study created a mobile platform called “Mind Mirror” to evaluate psychological and physical conditions and investigated whether PHRs would be a useful tool for assessment of the dynamic relationship between the emotional and physical conditions of an individual.Methods: Mind Mirror was used to collect 30 days of observational data about emotional valence and the physical states of pain and fatigue from 20 healthy participants, and these data were used to analyze the dynamic relationship between emotional and physical conditions. Additionally, based on the cross-correlations between these three parameters, a multilevel multivariate regression model (mixed linear model [MLM] was implemented.Results: The strongest cross-correlation between emotional and physical conditions was at lag 0, which implies that emotion and body condition changed concurrently. In the MLM, emotional valence was negatively associated with fatigue (β =-0.233, P<0.001, fatigue was positively associated with pain (β =0.250, P<0.001, and pain was positively associated with fatigue (β =0.398, P<0.001.Conclusion: Our study showed that emotional valence and one’s physical condition negatively influenced one another, while fatigue and pain positively affected each other. These findings suggest that the mind and body interact instantaneously, in
Mackay, Daniel F; Smith, Gordon C S; Cooper, Sally-Ann; Wood, Rachael; King, Albert; Clark, David N; Pell, Jill P
Learning disabilities have profound, long-lasting health sequelae. Affected children born over the course of 1 year in the United States of America generated an estimated lifetime cost of $51.2 billion. Results from some studies have suggested that autistic spectrum disorder may vary by season of birth, but there have been few studies in which investigators examined whether this is also true of other causes of learning disabilities. We undertook Scotland-wide record linkage of education (annual pupil census) and maternity (Scottish Morbidity Record 02) databases for 801,592 singleton children attending Scottish schools in 2006-2011. We modeled monthly rates using principal sine and cosine transformations of the month number and demonstrated cyclicity in the percentage of children with special educational needs. Rates were highest among children conceived in the first quarter of the year (January-March) and lowest among those conceived in the third (July-September) (8.9% vs 7.6%; P disabilities, and learning difficulties (e.g., dyslexia) and were absent for sensory or motor/physical impairments and mental, physical, or communication problems. Seasonality accounted for 11.4% (95% confidence interval: 9.0, 13.7) of all cases. Some biologically plausible causes of this variation, such as infection and maternal vitamin D levels, are potentially amendable to intervention. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Pieri, Massimo; Cialoni, Danilo; Marroni, Alessandro
Insulin-dependent diabetes has been considered a scuba diving contraindication. This is currently being reconsidered for well-controlled diabetes. We developed a real-time continuous glucose monitor (CGM) to check glycemia, or blood glucose (BG), during diving, both for prospective studies and to increase diabetic diver safety, allowing for real-time control of glycemia and hypoglycemia prevention. To ensure CGM measurement accuracy we tested the method under hyperbaric conditions. Two experienced diabetic divers were studied during a one-week diving cruise. BG was monitored every five minutes on every dive, by a dedicated CGM, and values were visible to the divers throughout their dives. The mean of relative difference (MRD) between CGM and capillary blood glucose was calculated. Measurement accuracy was assessed according to ISO guideline 15197 and by Clarke Error Grid (CEG) analysis. Both divers showed gradual BG decrease during diving. Hyperbaric chamber accuracy tests showed two of 26 MRD values (7.7%) slightly exceeding the ISO-15197 allowed difference (5%). However, our data suggest that this discrepancy may have been an artefact. Our data (even limited to two subjects only) agree with the current literature showing that also in our investigated subjects diving does not imply significant risks of hypoglycemia. The use of a real-time CGM by diabetic divers during their dives can provide immediate information on BG values and trends, thus significantly improving diving safety. The accuracy tests comparing continuous glucose monitoring (CGM) and capillary blood glucose measurement (CBM) data recorded under hyperbaric conditions showed that data recorded under pressure are very close to the ISO-15197 and CEG acceptable limits.
Simon, Justin I.; Matzel, J. E. P.; Simon, S. B.; Weber, P. K.; Grossman, L.; Ross, D. K.; Hutcheon, I. D.
Ca-, Al-rich inclusions (CAIs) record the O-isotope composition of Solar nebular gas from which they grew . High spatial resolution O-isotope measurements afforded by ion microprobe analysis across the rims and margin of CAIs reveal systematic variations in (Delta)O-17 and suggest formation from a diversity of nebular environments [2-4]. This heterogeneity has been explained by isotopic mixing between the O-16-rich Solar reservoir  and a second O-16-poor reservoir (probably nebular gas) with a "planetary-like" isotopic composition [e.g., 1, 6-7], but the mechanism and location(s) where these events occur within the protoplanetary disk remain uncertain. The orientation of large and systematic variations in (Delta)O-17 reported by  for a compact Type A CAI from the Efremovka reduced CV3 chondrite differs dramatically from reports by  of a similar CAI, A37 from the Allende oxidized CV3 chondrite. Both studies conclude that CAIs were exposed to distinct, nebular O-isotope reservoirs, implying the transfer of CAIs among different settings within the protoplanetary disk . To test this hypothesis further and the extent of intra-CAI O-isotopic variation, a pristine compact Type A CAI, Ef-1 from Efremovka, and a Type B2 CAI, TS4 from Allende were studied. Our new results are equally intriguing because, collectively, O-isotopic zoning patterns in the CAIs indicate a progressive and cyclic record. The results imply that CAIs were commonly exposed to multiple environments of distinct gas during their formation. Numerical models help constrain conditions and duration of these events.
Gupta, Anamika; Mishra, Gaurav; Bhutani, Hemant; Hoshing, Chetan; Bhalla, Ashish
Objectives: With the growth of forensic odontology, dental records have become an essential source of information, especially for medicolegal cases in general practice. It is mandated by the law that every dentist must keep some kind of records for every patient they treat. After the death of an individual, remnants of teeth are usually damaged at the last among all body parts. Dental records assist in personal identification in cases of mass disasters, criminal investigations, and medicolega...
Full Text Available Introduction. A playful competition was launched in a primary dental health care system to improve the recording of diagnoses into an electronic patient chart system and to study what diagnoses were used in primary dental care. Methods. This was a longitudinal follow-up study with public sector primary dental care practices in a Finnish city. A one-year-lasting playful competition between the dental care teams was launched and the monthly percentage of dentists’ visits with recorded diagnosis before, during, and after the intervention was recorded. The assessed diagnoses were recorded with the International Classification of Diseases (ICD-10. Results. Before the competition, the level of diagnosis recordings was practically zero. At the end of this intervention, about 25% of the visits had a recorded diagnosis. Two years after the competition, this percentage was 35% without any additional measures. The most frequent diagnoses were dental caries (K02, 38.6%, other diseases of hard tissues of teeth (K03, 14.8%, and diseases of pulp and periapical tissues (K04, 11.4%. Conclusions. Commitment to the idea that recording of diagnoses was beneficial improved the recording of dental diagnoses. However, the diagnoses obtained did not accurately reflect the reputed prevalence of oral diseases in the Finnish population.
Ray, Charles M.
This discussion of evaluating a records management course includes comments on management orientation, creation of records, maintenance of records, selection and use of equipment, storage and destruction of records, micrographics, and a course outline. (TA)
Bhavnani, Vanita; Fisher, Brian; Winfield, Marlene; Seed, Paul
Record access is likely to become an integral part of routine care in the UK. While existing research suggests that record access improves self-care and improves relationships between patients and clinicians, little is known about how patients make use of their ability to access their records or the impact that this has on health behaviour. To explore patients' use of access to their electronic GP record and the impact of that process on their health behaviour. Self-administered postal questionnaire mailed from three general practice surgeries to patients registered to use PAERS record access system. Data were analysed using SPSS. Content analysis was used to analyse free-text responses. Two hundred and thirty-one of 610 patients responded. Frequent users of Record Access were those in poor health. Record access was used to look at test results and to read letters from those involved in health care. Forty-two per cent reported a positive impact on following medication advice and 64% a positive impact on following lifestyle advice. Just over half the sample felt accessing records prior to appointments saved time and wanted to share records with other health care providers. Approximately a third reported difficulties with understanding their records. Record access appears to have a number of positive outcomes and very few negative ones, although further work is needed to confirm this. It is used by patients to help practices improve efficiency and to improve compliance. It has the potential to promote and reinforce collaborative relationships between clinicians and patients.
Bin, Yu Sun; Cistulli, Peter A; Roberts, Christine L; Ford, Jane B
Sleep apnea in pregnancy is known to adversely affect birth outcomes. Whether in utero exposure to maternal sleep apnea is associated with long-term childhood consequences is unclear. Population-based longitudinal study of singleton infants born during 2002-2012 was conducted using linked birth, hospital, death, developmental, and educational records from New South Wales, Australia. Maternal sleep apnea during pregnancy was identified from hospital records. Outcomes were mortality and hospitalizations up to age 6, developmental vulnerability in the first year of school (aged 5-6 years), and performance on standardized tests in the third year of school (aged 7-9 years). Cox proportional hazards and modified Poisson regression models were used to calculate hazard and risk ratios for outcomes in children exposed to maternal apnea compared with those not exposed. Two hundred nine of 626188 singleton infants were exposed to maternal sleep apnea. Maternal apnea was not significantly associated with mortality (Fisher's exact p = .48), developmental vulnerability (adjusted RR 1.29; 95% CI 0.75-2.21), special needs status (1.58; 0.61-4.07), or low numeracy test scores (1.03; 0.63-1.67) but was associated with low reading test scores (1.55; 1.08-2.23). Maternal apnea significantly increased hospitalizations in the first year of life (adjusted HR 1.81; 95% CI 1.40-2.34) and between the first and sixth birthdays (1.41; 1.14-1.75). This is partly due to admissions for suspected pediatric sleep apnea. Maternal sleep apnea during pregnancy is associated with poorer childhood health. Its impact on developmental and cognitive outcomes warrants further investigation. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail email@example.com.
The introduction of computers into general practice settings has profoundly changed the dynamics of the clinical consultation. Previous research exploring the impact of the computer (in what has been termed the 'triadic' consultation) has shown that computer use and communication between doctor and patient are intricately coordinated and inseparable. Swinglehurst et al. have recently been critical of the ongoing tendency within health communication research to focus on 'the computer' as a relatively simple 'black box', or as a material presence in the consultation. By re-focussing on the electronic patient record (EPR) and conceptualising this as a complex collection of silent but consequential voices, they have opened up new and more nuanced possibilities for analysis. This orientation makes visible a tension between the immediate contingencies of the interaction as it unfolds moment-by-moment and the more standardised, institutional demands which are embedded in the EPR ('dilemma of attention'). In this paper I extend this work, presenting an in-depth examination of how participants in the consultation manage this tension. I used linguistic ethnographic methods to study 54 video recorded consultations from a dataset collected between 2007 and 2008 in two UK general practices, combining microanalysis of the consultation with ethnographic attention to the wider organisational and institutional context. My analysis draws on the theoretical work of Erving Goffman and Mikhail Bakhtin, incorporating attention to the 'here and now' of the interaction as well as an appreciation of the 'distributed' nature of the EPR, its role in hosting and circulating new voices, and in mediating participants' talk and social practices. It reveals - in apparently fleeting moments of negotiation and contestation - the extent to which the EPR shapes the dynamic construction, display and circulation of authority in the contemporary consultation. Copyright © 2014 The Author. Published by
... students' school transcripts. It is also our intention to include in this system of records students..., school experiences, and key outcomes for transition-age students with an Individualized Education Plan... contain records from 500 school districts on approximately 15,000 students and their parents, 15,000...
Rhoads, James B.
Produced as part of the United Nations Educational, Scientific, and Cultural Organization (UNESCO) Records and Archives Management Programme (RAMP), this publication provides information about the essential character and value of archives and about the procedures and programs that should govern the management of both archives and current records,…
Atomic Energy Commission, Washington, DC.
THE SUCCESSFUL OPERATION OF THE PERMISSIBLE LEVEL CONCEPT OF RADIATION CONTROL NECESSARILY ENTAILS A COMPREHENSIVE SYSTEM UNDER WHICH EXPOSURE MUST BE RECORDED AND EMPLOYEES NOTIFIED OF THEIR EXPOSURE HISTORY. IN AN INVESTIGATION OF RECORD KEEPING NECESSARY TO PROCESS RADIATION CLAIMS, QUESTIONNAIRES OR LETTERS WERE RECEIVED FROM 45 STATE AGENCIES…
The electronic medical record (EMR) is an information technology tool supporting the examination, treatment, and care of a patient. The EMR allows physicians to view a patient's record showing current medications, a history of visits from health care providers with notes from those visits, a problem list, a functional status assessment, a schedule…
Hasselberg, Karin; Jonsdottir, Ingibjörg H; Ellbin, Susanne; Skagert, Katrin
Several researchers imply that both work-related and non-work-related stress exposure are likely to contribute to stress-related mental illness. Yet empirical studies investigating both domains seem to be limited, particularly in a clinical population. The purpose of this study was to a) explore which stressors (non-work and work-related) are reported as important for the onset of illness by patients seeking medical care for stress-related exhaustion and b) explore the prevalence of each stressor and examine whether the pattern differs between men and women. This is an exploratory mixed method study, comprising patients at a specialist outpatient stress clinic. Information from medical records of 20 patients was initially used in a first qualitative step to construct the instrument, using a combination of a conventional content analysis and a directed content analysis. In the second phase patient records from 50 men and 50 women were selected and coded in accordance with the coding instrument. Frequency statistics were calculated for all stressors. A total of 24 categories of stressors (11 related to work and 13 related to private life) were identified in the first qualitative step. A median of four stressors, usually both work and non-work-related was reported by the patients. The most common stressors were 1) quantitative demands at work, 2) private relational conflicts and 3) emotional demands at work. Work demands are, by far, the most prevalent stressor, followed by relational problems in private life. The pattern was similar for women and men, with a slight difference in the distribution between work and non-work stressors. Men and women also show similar patterns when comparing the occurrence of each stressor. Slight differences were seen, in particular with regard to managerial responsibility that was reported by 6% of the women compared to 36% of the men. One important practical implication of this study is that patients with stress-related exhaustion
Background Several researchers imply that both work-related and non-work-related stress exposure are likely to contribute to stress-related mental illness. Yet empirical studies investigating both domains seem to be limited, particularly in a clinical population. The purpose of this study was to a) explore which stressors (non-work and work-related) are reported as important for the onset of illness by patients seeking medical care for stress-related exhaustion and b) explore the prevalence of each stressor and examine whether the pattern differs between men and women. Methods This is an exploratory mixed method study, comprising patients at a specialist outpatient stress clinic. Information from medical records of 20 patients was initially used in a first qualitative step to construct the instrument, using a combination of a conventional content analysis and a directed content analysis. In the second phase patient records from 50 men and 50 women were selected and coded in accordance with the coding instrument. Frequency statistics were calculated for all stressors. Results A total of 24 categories of stressors (11 related to work and 13 related to private life) were identified in the first qualitative step. A median of four stressors, usually both work and non-work-related was reported by the patients. The most common stressors were 1) quantitative demands at work, 2) private relational conflicts and 3) emotional demands at work. Conclusions Work demands are, by far, the most prevalent stressor, followed by relational problems in private life. The pattern was similar for women and men, with a slight difference in the distribution between work and non-work stressors. Men and women also show similar patterns when comparing the occurrence of each stressor. Slight differences were seen, in particular with regard to managerial responsibility that was reported by 6% of the women compared to 36% of the men. One important practical implication of this study is that
P. P. Sharma
Full Text Available A promising strategy to get deeper insight on brain functionalities relies on the investigation of neural activities at the cellular and sub-cellular level. In this framework, methods for recording neuron electrical activity have gained interest over the years. Main technological challenges are associated to finding highly sensitive detection schemes, providing considerable spatial and temporal resolution. Moreover, the possibility to perform non-invasive assays would constitute a noteworthy benefit. In this work, we present a magnetoresistive platform for the detection of the action potential propagation in neural cells. Such platform allows, in perspective, the in vitro recording of neural signals arising from single neurons, neural networks and brain slices.
Kaoli Pereira Cavalcante
Full Text Available There have been few taxonomic studies of centric diatoms in lotic freshwater environments in Brazil, especially in terms of those including nanoplanktonic forms, which are often neglected in studies of local floras, because of their small size or confusing taxonomy. This is the first study focusing on centric diatoms in the flora of the state of Bahia, in northeastern Brazil. Plankton and periphyton attached to Eichornia crassipes were collected in the winter of 2009 in the Cachoeira River. The diatoms were analyzed and described under light and electron microscopies. Seventeen infrageneric taxa were identified. Cyclotella was represented by five taxa, and concerning of similarities between diacritical features of species in this genus, their descriptions were thoroughly detailed. This was the first time that Cyclotella atomus var. marina, previously recorded only in coastal areas of Japan and Korea, has been documented in a river in South America. We also identified two diatom taxa previously unrecorded in the flora of Brazil: C. cryptica and C. meduanae. Finally, we present a detailed light, transmission and scanning electron microscopy analysis of Skeletonema potamos, a diatom rarely found in the Brazilian literature.
Sockolow, Paulina S; Bowles, Kathryn H; Lehmann, Harold P; Abbott, Patricia A; Weiner, Jonathan P
This multimethod study measured the impact of an electronic health record (EHR) on clinician satisfaction with clinical process. Subjects were 39 clinicians at a Program of All-inclusive Care for Elders (PACE) site in Philadelphia utilizing an EHR. Methods included the evidence-based evaluation framework, Health Information Technology Research-Based Evaluation Framework, which guided assessment of clinician satisfaction with surveys, observations, follow-up interviews, and actual EHR use at two points in time. Mixed-methods analysis of findings provided context for interpretation and improved validity. The study found that clinicians were satisfied with the EHR; however, satisfaction declined between time periods. Use of EHR was universal and wide and was differentiated by clinical role. Between time periods, EHR use increased in volume, with increased timeliness and decreased efficiency. As the first EHR evaluation at a PACE site from the perspective of clinicians who use the system, this study provides insights into EHR use in the care of older people in community-based healthcare settings.
da Rosa, João Aristeu; Souza, Eder Santos; da Costa Teixeira, Adelson; Barbosa, Rosenildo Ribeiro; de Souza, Aecildo José; Belintani, Tiago; Nascimento, Juliana Damieli; Gil-Santana, Hélcio Reinaldo; de Oliveira, Jader
Rhodnius amazonicus Almeida et al. (1973) is a triatomine of rare occurrence. This species was found for the third time in Breves city, Pará state, Brazil. Morphometric and morphological studies were carried out on one male and one female. Lent and Wygodzinsky (1979) considered this species as a synonym of R. pictipes, until its revalidation after 23 years by Bérenger and Pluot-Sigwalt (2002). Considering the synonym mentioned above, a comparative study between these two species was performed in order to report the third encounter of this species, and increase the number of morphological characters that distinguish R. amazonicus from R. pictipes. The dorsal side of the head, the dorsal and ventral portions of the thorax, the dorsal, ventral and posterior sides of the female genitalia, eggs and the median process of the pygophore were examined by scanning electronic microscopy (SEM). The head, thorax, abdomen and egg parameters of these two species were also measured. The identification of characters on the head, stridulatory sulcus, mesosternum, metasternum, scutellum, process of urotergite I, external female genitalia, pygophore and eggs made the distinction between R. amazonicus and R. pictipes possible. This study has shown the new characters recorded and described for the first time for R. amazonicus and R. pictipes by SEM here made it possible to confirm the morphological separation between these two species. The morphometric analysis also confirmed that the above two taxa are different at specific level. Copyright © 2017. Published by Elsevier B.V.
Gromig, R.; Melles, M.; Wagner, B.; Krastel, S.; Andreev, A.; Fedorov, G.; Just, J.; Wennrich, V.; Savelieva, L.; Subetto, D.; Shumilovskikh, L.
The joint German-Russian project 'PLOT - Paleolimnological Transect' aims to recover lake sediment sequences along a more than 6000 km long longitudinal transect across the Eurasian Arctic in order to study the Late Quaternary climatic and environmental history. The eastern end of the PLOT transect is formed by the well-studied record from Lake El'gygytgyn (NE Siberia). Lake Ladoga (N 60°50' E 31°30') is Europe's largest lake, both by size and volume and forms the westernmost end of the transect. Whereas modern sedimentation as well as the Holocene and Late Glacial history of Lake Ladoga have intensely been studied, the preglacial history of the lake is poorly studied to date by sediment cores drilled in the 1930's. A seismic survey of Lake Ladoga in summer 2013 revealed unconformities in the western lake basin, which may separate preglacial sediments in isolated depressions from Late Glacial and Holocene sediment successions above. A 23 m long sediment core (Co1309) was retrieved from one of these depressions. Core Co1309 was investigated by XRF-scanning, magnetic susceptibility measurements, as well as pollen, grain-size, and bio-geochemical analyses. An age-depth model combining radiocarbon, OSL, and paleomagnetic dates is in progress. Both, the pollen results and the OSL ages from the base of the record indicate a deposition during MIS 5e (Eemian). The well sorted reddish sands from this interval contain dinoflagellates suggesting at least brackish conditions, likely due to the existence of a gateway connecting a precursor of the Baltic Sea with the White Sea via Lake Ladoga. The Late Glacial sequence consists of greyish varved clays of decreasing thickness upwards with sporadically intercalated sand layers. The Holocene sequence is composed of brownish diatomaceous silty clay with minor proportions of sand.
de Winter, Niels J.; Vellekoop, Johan; Vorsselmans, Robin; Golreihan, Asefeh; Petersen, Sierra V.; Meyer, Kyle W.; Speijer, Robert P.; Claeys, Philippe
trace element and stable isotope records allow discussion of the degree to which Pycnodonte shells record their palaeoenvironment and can be used to reconstruct past sea water conditions. Preliminary results indicate that stable isotope and trace element ratios in Pynodonte shells record different seasonally changing sea water conditions in the Maastrichtian and reconstructed temperatures are consistent with results from clumped isotope analysis on the same shells and TEX86 analysis on the surrounding rocks. This multi-proxy study sheds light on the shell structure of Pycnodonte oysters, their chemical signature and growth pattern and investigates the expression of palaeoenvironmental proxies in the pristine shell calcite of these bivalves. This investigation shows the potential of using fossil Pycnodonte bivalves as a new archive for palaeoclimate reconstruction on a seasonal scale over a wide range of palaeolatitudes from the Cretaceous until the Pleistocene. References Huyghe et al. (2015) J. Geol Soc 172.5: 576-587. Videt (2003) Diss. Université Rennes 1. Wisshak, et al. (2009) Deep-Sea Res Pt I 56.3: 374-407.
Vassy, Jason L; Ho, Yuk-Lam; Honerlaw, Jacqueline; Cho, Kelly; Gaziano, J Michael; Wilson, Peter W F; Gagnon, David R
Despite growing interest in using electronic health records (EHR) to create longitudinal cohort studies, the distribution and missingness of EHR data might introduce selection bias and information bias to such analyses. We aimed to examine the yield and potential for these healthcare process biases in defining a study baseline using EHR data, using the example of cholesterol and blood pressure (BP) measurements. We created a virtual cohort study of cardiovascular disease (CVD) from patients with eligible cholesterol profiles in the New England (NE) and Southeast (SE) networks of the Veterans Health Administration in the United States. Using clinical data from the EHR, we plotted the yield of patients with BP measurements within an expanding timeframe around an index date of cholesterol testing. We compared three groups: (1) patients with BP from the exact index date; (2) patients with BP not on the index date but within the network-specific 90th percentile around the index date; and (3) patients with no BP within the network-specific 90th percentile. Among 589,361 total patients in the two networks, 146,636 (61.0%) of 240,479 patients from NE and 289,906 (83.1%) of 348,882 patients from SE had BP measurements on the index date. Ninety percent had BP measured within 11 days of the index date in NE and within 5 days of the index date in SE. Group 3 in both networks had fewer available race data, fewer comorbidities and CVD medications, and fewer health system encounters. Requiring same-day risk factor measurement in the creation of a virtual CVD cohort study from EHR data might exclude 40% of eligible patients, but including patients with infrequent visits might introduce bias. Data visualization can inform study-specific strategies to address these challenges for the research use of EHR data. Published by Elsevier Inc.
Full Text Available Depending mostly on voluntarily sent spontaneous reports, pharmacovigilance studies are hampered by low quantity and quality of patient data. Our objective is to improve postmarket safety studies by enabling safety analysts to seamlessly access a wide range of EHR sources for collecting deidentified medical data sets of selected patient populations and tracing the reported incidents back to original EHRs. We have developed an ontological framework where EHR sources and target clinical research systems can continue using their own local data models, interfaces, and terminology systems, while structural interoperability and Semantic Interoperability are handled through rule-based reasoning on formal representations of different models and terminology systems maintained in the SALUS Semantic Resource Set. SALUS Common Information Model at the core of this set acts as the common mediator. We demonstrate the capabilities of our framework through one of the SALUS safety analysis tools, namely, the Case Series Characterization Tool, which have been deployed on top of regional EHR Data Warehouse of the Lombardy Region containing about 1 billion records from 16 million patients and validated by several pharmacovigilance researchers with real-life cases. The results confirm significant improvements in signal detection and evaluation compared to traditional methods with the missing background information.
Sines, Chad C; Griffin, Gerald R
The Health Information Technology for Economic and Clinical Health (HITECH) Act established the requirement of all medical practices to have certified electronic health records (EHRs). Some primary concerns that have been delaying implementation are issues of cost, revenue impact, and the effect on the patient encounter. Small physician practices (one to four physicians) account for 46 percent of all physicians. The purpose of this qualitative study using a modified Delphi research design was to examine the potential effect of the adoption of the EHR on revenue, unintended costs or savings, and changes in the patient encounter. Fifteen expert panelists completed the three-round survey process. The expert panelists reached a consensus that EHRs would reduce the number of patients seen per day, thereby reducing their revenue. Although the panelists limited their discussion on the effect of patient outcomes, their most dominant concern was the loss of face-to-face time with the patient. They felt that the use of an EHR would reduce the focus on the patient and potentially cause physicians to miss medical conditions. The results of this study indicate an avenue for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact.
Full Text Available Abstract Background Various factors affect tooth loss in older age including cigarette smoking; however, evidence regarding the association between smoking and tooth loss during young adulthood is limited. The present study examined the association between cigarette smoking and tooth loss experience among adults aged 20–39 years using linked data from two national databases in Japan. Methods Two databases of the National Nutrition Survey (NNS and the Survey of Dental Diseases (SDD, which were conducted in 1999, were obtained from the Ministry of Health, Labor and Welfare with permission for analytical use. In the NNS, participants received physical examinations and were interviewed regarding dietary intake and health practices including cigarette smoking, whereas in the SDD, participants were asked about their frequency of daily brushing, and received oral examinations by certified dentists. Among 6,805 records electronically linked via household identification code, 1314 records of individuals aged 20 to 39 years were analyzed. The prevalence of 1+ tooth loss was compared among non-, former, and current smokers. Multiple logistic regression models were constructed including confounders: frequency of tooth brushing, body mass index, alcohol consumption, and intake of vitamins C and E. Results Smoking rates differed greatly in men (53.3% and women (15.5%. The overall prevalence of tooth loss was 31.4% (31.8% men and 31.1% women. Tooth loss occurred more frequently among current smokers (40.6% than former (23.1% and non-smokers (27.9%. Current smoking showed a significant association with 1+ tooth loss in men (adjusted OR = 2.21 [1.40–3.50], P = 0.0007 and women (1.70 [1.13–2.55], P = 0.0111. A significant positive exposure-related relationship between cigarette smoking status and tooth loss was observed (P for trend Conclusion An association between cigarette smoking and tooth loss was evident among young adults throughout Japan. Due to
Lee, Wei Wei; Alkureishi, Maria A; Ukabiala, Obioma; Venable, Laura Ruth; Ngooi, Samantha S; Staisiunas, Daina D; Wroblewski, Kristen E; Arora, Vineet M
While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. This was a prospective mixed-methods study. Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the "Clinical Care" subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the "Communication Functions" theme, and the majority of those related to the "Physical Focus" subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive
McGovern, Andrew Peter; Woodman, Jenny; Allister, Janice; van Vlymen, Jeremy; Liyanage, Harshana; Jones, Simon; Rafi, Imran; de Lusignan, Simon; Gilbert, Ruth
Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording. To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records. Clinical audit of rates of maltreatment-related coding before January 2010-December 2011 and after January-December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code 'Child is cause for concern'. A total of 25,106 children aged 0-18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording. Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern. We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1-1.6), child protection procedures (RR 1.4; 95% CI 1.1-1.6) and cause for concern (RR 2.5; 95% CI 1.8-3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation. This simple coding strategy improved clinician's recording of maltreatment-related concerns in a small sample of practices with some 'buy-in'. Further research should investigate how recording can best support the doctor-patient relationship. HOW THIS FITS IN: Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial under-recording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns
Jackson, Holly; Barnett, Lauren A; Jordan, Kelvin P; Dziedzic, Krysia S; Cottrell, Elizabeth; Finney, Andrew G; Paskins, Zoe; Edwards, John J
To determine common patterns of recorded primary care for osteoarthritis (OA), and patient and provider characteristics associated with the quality of recorded care. An observational study nested within a cluster-randomised controlled trial. Eight UK general practices who were part of the Management of Osteoarthritis in Consultations study. Patients recorded as consulting within the eight general practices for clinical OA. Achievement of seven quality indicators of care (pain/function assessment, information provision, exercise/weight advice, analgesics, physiotherapy), recorded through an electronic template or routinely recorded in the electronic healthcare records, was identified for patients aged ≥45 years consulting over a 6-month period with clinical OA. Latent class analysis was used to cluster patients based on care received. Clusters were compared on patient and clinician-level characteristics. 1724 patients (median by practice 183) consulted with clinical OA. Common patterns of recorded quality care were: cluster 1 (38%, High ) received most quality indicators of care; cluster 2 (11%, Moderate ) had pain and function assessment, and received or were considered for other indicators; cluster 3 (17%, Low ) had pain and function assessment, and received or were considered for paracetamol or topical non-steroidal anti-inflammatory drugs; cluster 4 (35%, None ) had no recorded quality indicators. Patients with higher levels of recorded care consulted a clinician who saw more patients with OA, consulted multiple times and had less morbidity. Those in the High cluster were more likely to have recorded diagnosed OA and have knee/hip OA. Patterns of recorded care for OA fell into four natural clusters. Appropriate delivery of core interventions and relatively safe pharmacological options for OA are still not consistently recorded as provided in primary care. Further research to understand clinical recording behaviours and determine potential barriers to quality
Full Text Available Overheating is constantly mentioned as a risk factor for bone necrosis that could compromise the dental implant primary stability. Uncontrolled thermal injury can result in a fibrous tissue, interpositioned at the implant-bone interface, compromising the long-term prognosis. The methods used to record temperature rise include either direct recording by thermocouple instruments or indirect estimating by infrared thermography. This preliminary study was carried out using bovine bone and a different method of temperatures rising estimation is presented. Two different types of drills were tested using fluoroptic thermometer and the effectiveness of this alternative temperature recording method was evaluated.
Karusisi, Noëlla; Thomas, Frédérique; Méline, Julie; Chaix, Basile
Physical activity is considered as a major component of a healthy lifestyle. However, few studies have examined the relationships between the spatial accessibility to sport facilities and sport practice with a sufficient degree of specificity. The aim of this study was to investigate the associations between the spatial accessibility to specific types of sports facilities and the practice of the corresponding sports after carefully controlling for various individual socio-demographic characteristics and neighborhood socioeconomic variables. Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Four categories of sports were studied: team sports, racket sports, swimming and related activities, and fitness. Spatial accessibility to sport facilities was measured with two complementary approaches that both take into account the street network (distance to the nearest facility and count of facilities around the dwelling). Associations between the spatial accessibility to sport facilities and the practice of the corresponding sports were assessed using multilevel logistic regression after adjusting for individual and contextual characteristics. High individual education and high household income were associated with the practice of racket sports, swimming or related activities, and fitness over the previous 7 days. The spatial accessibility to swimming pools was associated with swimming and related sports, even after adjustment for individual/contextual factors. The spatial accessibility to facilities was not related to the practice of other sports. High neighborhood income was associated with the practice of a racket sport and fitness. Accessibility is a multi-dimensional concept that integrates educational, financial, and geographical aspects. Our work supports the evidence that strategies to increase participation in sport activities should improve the spatial and
Andrew Peter McGovern
Full Text Available Background Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC and National Institute for Health and Clinical Excellence (NICE but there is evidence of substantial under-recording.Aim To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records.Design and Setting Clinical audit of rates of maltreatment-related coding before January 2010–December 2011 and after January–December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code ‘Child is cause for concern’. A total of 25,106 children aged 0–18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording.Method Outcomes were recording of 1 any maltreatment-related codes, 2 child protection proceedings and 3 child was a cause for concern.Results We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1–1.6, child protection procedures (RR 1.4; 95% CI 1.1–1.6 and cause for concern (RR 2.5; 95% CI 1.8–3.4 after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation.Conclusion This simple coding strategy improved clinician’s recording of maltreatment-related concerns in a small sample of practices with some ‘buy-in’. Further research should investigate how recording can best support the doctor–patient relationshipHow this fits in Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC and National Institute for Health and Clinical Excellence (NICE, but there is evidence of substantial underrecording. We describe a simple clinical coding
Full Text Available Here we summarize the known distributional data for the Hawaiian Scatella (Ephydridae. We report on four new island records; S. amnica and S. stagnalis from Kauai, S. oahuense from Lanai, and S. terryi from Maui. A list of material present, comprising over 3100 individual specimen records in the collections of the Bernice Pauahi Bishop Museum, University of Hawaii at Manoa, and Essig Musuem of Entomology at UC Berkeley is included, along with details distributional maps for the Hawaiian endemic species.
Yıldız, Mustafa; Yazıcı, Ayla; Böke, Omer
The aim of the present study is to assess the relationship between demographic characteristics and suicide attempts, physically aggressive behavior, substance abuse, repeated hospitalizations, and continuous illness course . The medical records of patients from three different treatment centers were assessed. The relationship between demographics and clinical characteristics were assessed. Logistic regression analysis was conducted to determine the predicting factors for suicide attempts, physically aggressive behavior, heavy smoking, repeated hospitalizations, and continuous illness course. The medical records of a total of 720 patients with schizophrenia were assessed. Of these patients, 68% were never married, 56% were unemployed, and 69% were living with their parents. 35% of the patients had a relative diagnosed with a psychotic disorder. The mean age for the onset of the illness was found to be 23.5, with no difference between females and males. 50% of the patients had had repeated hospitalizations. The duration of untreated psychosis was 10.8 months and 28% of the patients had been through a continuous course of the illness. 57% of the patients were found to be regular smokers; 55% of the patients had physically aggressive behavior; 52% had experienced a suicidal ideation and attempt; 28% had made at least one suicide attempt. The percentage of patients having had a legal issue related to their illness was 11%. Heavy smoking was predicted with the continuous illness and male gender. Physically aggressive behavior was predicted with suicide ideation and attempts, being single, having insufficient family support, and having undergone frequent hospitalization. Repeated hospitalizations were predicted with suicide attempts and having a legal problems; continuous course of illness was predicted with being unemployed and lack of family support; suicide attempt was predicted with duration of the illness. When both sexes were compared, the lack of difference at the
Romanelli, Robert J; Nimbal, Vani; Dutcher, Sarah K; Pu, Xia; Segal, Jodi B
Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. We sought to evaluate determinants of generic prescribing of levothyroxine. In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with a levothyroxine prescription from a primary-care physician (PCP) or endocrinologist. We used mixed-effect logistic regression models with random intercepts for prescribing provider to examine predictors of generic levothyroxine prescribing. Models include patient, prescription, and provider fixed-effect covariates. Odds ratios (ORs) and 95% CIs were generated. Between-provider random variation was quantified by the intraclass correlation coefficient (ICC). Study patients (n = 63 838) were clustered among 941 prescribing providers within 25 ambulatory care clinics. The overall prevalence of generic prescribing of levothyroxine was 73%. In the multivariable mixed-effect model, patients were significantly less likely to receive generic levothyroxine from an endocrinologist than a PCP (OR = 0.43; 95% CI = 0.33-0.55; P levothyroxine than men from endocrinologists (OR = 0.68; 95% CI = 0.59-0.78; P levothyroxine prescribing differed by PCPs and endocrinologists. Residual variation in generic prescribing, after accounting for measurable factors, indicates the need for provider interventions or patient education aimed at improving levothyroxine generic uptake.
Andersen, S E
To identify organisational difficulties faced by physicians and nurses when using drug prescribing sheets for recording both drug prescriptions and drug administration. Qualitative interview study. Two general internal medicine wards. Seven physicians and eight nurses. Difficulties explicitly identified by the participants during the interviews. The implementation of procedures conflicted with existing structure, culture, and routines. Insufficient competence within the system to use the drug prescribing sheets created resistance and made people down the line create their own interpretations and solutions to the problems they faced. A total of nine problems were identified: (1) insufficient knowledge and uncertainty about procedures, (2) ignorance of sources of error, (3) unclear responsibilities, (4) low community spirit, (5) insufficient communication, (6) clinician autonomy and low acceptance of change, (7) strong professional identity, (8) low priority task, and (9) logistical problems. Unawareness of procedures, insufficient dissemination of knowledge, and insufficient cooperation and skepticism among those who put drug handling into practice is likely to have an impact on the quality of health care. The identification of these obstacles may help managers to improve the quality of the drug handling process on internal medicine wards and make it possible to select a framework for changing the clinical behaviour of doctors and nurses.
Castro Conde, José Ramón; González González, Nieves Luisa; González Barrios, Desiré; González Campo, Candelaria; Suárez Hernández, Yaiza; Sosa Comino, Elena
To determine whether full-term newborn infants of diabetic mothers (IDM) present immature/disorganised EEG patterns in the immediate neonatal period, and whether there was any relationship with maternal glycaemic control. Cohort study with an incidental sample performed in a tertiary hospital neonatal unit. 23 IDM and 22 healthy newborns born between 2010 and 2013. All underwent video-EEG recording lasting >90 min at 48-72 h of life. We analysed the percentage of indeterminate sleep, transient sharp waves per hour and mature-for-gestational age EEG patterns (discontinuity, maximum duration of interburst interval (IBI), asynchrony, asymmetry, δ brushes, encoches frontales and α/θ rolandic activity). The group of IDM was divided into two subgroups according to maternal HbA1c: (1) HbA1c≥6% and (2) HbA1cIDM presented significantly higher percentage of indeterminate sleep (57% vs 25%; pIDM with maternal HbA1c≥6% showed greater percentage of δ brushes in the burst (14% vs 4%; p=0.007). Full-term IDM newborns showed video-EEG features of abnormal development of brain function. Maternal HbA1c levels<6% during pregnancy could minimise the risk of cerebral dysmaturity.
Rizer, Milisa K; Sieck, Cynthia; Lehman, Jennifer S; Hefner, Jennifer L; Huerta, Timothy R; McAlearney, Ann Scheck
To assess patient perceptions of electronic medical record (EMR) intrusiveness during ambulatory visits to clinics associated with a large academic medical center. We conducted a survey of patients seen at any of 98 academic medical center clinics. The survey assessed demographics, visit satisfaction, computer use, and perceived intrusiveness of the computer. Of 7,058 patients, slightly more than 80 percent reported that the physician had used the computer while in the room, but only 24 percent were shown results in the EMR. Most patients were very satisfied or satisfied with their visit and did not find the computer intrusive (83 percent). Younger respondents, those shown results, and those who reported that the physician used the computer were more likely to perceive the computer as intrusive. Qualitative comments suggest different perceptions related to computer intrusiveness than to EMR use more generally. Patients were generally accepting of EMRs and therefore use of computers in the exam room. However, subgroups of patients may require greater study to better understand patient perceptions related to EMR use and intrusiveness. Results suggest the need for greater focus on how physicians use computers in the exam room in a manner that facilitates maintaining good rapport with patients.
Wotton, Clare J; Goldacre, Michael J
To determine whether hospital admission for autoimmune disease is associated with an elevated risk of future admission for dementia. Retrospective, record-linkage cohort study using national hospital care and mortality administrative data, 1999-2012. Cohorts of people admitted to hospital with a range of autoimmune diseases were constructed, along with a control cohort, and followed forward in time to see if they developed dementia. 1 833 827 people were admitted to hospital with an autoimmune disease; the number of people in cohorts for each autoimmune disease ranged from 1019 people in the Goodpasture's syndrome cohort, to 316 043 people in the rheumatoid arthritis cohort. The rate ratio for dementia after admission for an autoimmune disease, compared with the control cohort, was 1.20 (95% CI 1.19 to 1.21). Where dementia type was specified, the rate ratio was 1.06 (1.04 to 1.08) for Alzheimer's disease and 1.28 (1.26 to 1.31) for vascular dementia. Of 25 autoimmune diseases studied, 18 showed significant positive associations with dementia at pdisease (1.48, 1.34 to 1.64), multiple sclerosis (1.97, 1.88 to 2.07), psoriasis (1.29, 1.25 to 1.34) and systemic lupus erythematosus (1.46, 1.32 to 1.61). The associations with vascular dementia may be one component of a broader association between autoimmune diseases and vascular damage. Though findings were significant, effect sizes were small. Clinicians should be aware of the possible coexistence of autoimmune disease and dementia in individuals. Further studies are needed to confirm or refute our findings and to explore possible mechanisms mediating any elevation of risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Full Text Available Abstract Background The electronic health record (EHR is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors. Methods A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada. At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary. Results The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings. Conclusions These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition
Landman, Adam; Emani, Srinivas; Carlile, Narath; Rosenthal, David I; Semakov, Simon; Pallin, Daniel J; Poon, Eric G
Background Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking. Objective The aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and...
Ramírez, I; Pantrigo, J J; Montemayor, A S; López-Pérez, A E; Martín-Fontelles, M I; Brookes, S J H; Abalo, R
When available, fluoroscopic recordings are a relatively cheap, non-invasive and technically straightforward way to study gastrointestinal motility. Spatiotemporal maps have been used to characterize motility of intestinal preparations in vitro, or in anesthetized animals in vivo. Here, a new automated computer-based method was used to construct spatiotemporal motility maps from fluoroscopic recordings obtained in conscious rats. Conscious, non-fasted, adult, male Wistar rats (n=8) received intragastric administration of barium contrast, and 1-2 hours later, when several loops of the small intestine were well-defined, a 2 minutes-fluoroscopic recording was obtained. Spatiotemporal diameter maps (Dmaps) were automatically calculated from the recordings. Three recordings were also manually analyzed for comparison. Frequency analysis was performed in order to calculate relevant motility parameters. In each conscious rat, a stable recording (17-20 seconds) was analyzed. The Dmaps manually and automatically obtained from the same recording were comparable, but the automated process was faster and provided higher resolution. Two frequencies of motor activity dominated; lower frequency contractions (15.2±0.9 cpm) had an amplitude approximately five times greater than higher frequency events (32.8±0.7 cpm). The automated method developed here needed little investigator input, provided high-resolution results with short computing times, and automatically compensated for breathing and other small movements, allowing recordings to be made without anesthesia. Although slow and/or infrequent events could not be detected in the short recording periods analyzed to date (17-20 seconds), this novel system enhances the analysis of in vivo motility in conscious animals. © 2017 John Wiley & Sons Ltd.
Karusisi, Noëlla; Bean, Kathy; Oppert, Jean-Michel; Pannier, Bruno; Chaix, Basile
The purpose of this study was to examine the associations between a broad range of environmental characteristics and jogging behavior while taking into account different complementary outcomes to describe the behavior. Using the RECORD Cohort Study (7290 participants, 2007-2008, Paris region, France), multilevel models were used to investigate individual/neighborhood variables associated with the probability of jogging; the time spent jogging; and the location of the practice. The presence and quality of green and open spaces was associated both with a greater probability of jogging [risk ratio (RR) for the first vs. the fourth quartile=1.22, 95% credible interval (CrI): 1.03-1.44] and with the practice of jogging within rather than outside the neighborhood (RR=1.29; 95% CrI: 1.10-1.53). Moreover, a high social cohesion and the presence of enjoyable places were associated with a higher probability of jogging (RR=1.15; 95% CrI: 1.00-1.31; RR=1.22; 95% CrI: 1.03-1.44) while the presence of parks or a lake increased the probability of jogging inside rather than outside the neighborhood (RR=1.29; 95% CrI: 1.10-1.53; RR=1.14; 95% CrI: 1.03-1.26). Paying attention to physical and social environments, related neighborhood experiences, and attitudes toward health may be an effective approach to promote outdoor physical activity. Copyright © 2012 Elsevier Inc. All rights reserved.
Briganti, Angela; Evangelista, Flavia; Centonze, Paola; Rizzo, Annaliso; Bentivegna, Francesco; Crovace, Antonio; Staffieri, Francesco
Haemodynamic variations normally occur in anaesthetized animals, in relation to the animal status, administered drugs, sympathetic and parasympathetic tone, fluid therapy and surgical stimulus. The possibility to measure some cardiovascular parameters, such as cardiac output (CO), during anaesthesia would be beneficial for both the anaesthesia management and its outcome. New techniques for the monitoring of CO are aimed at finding methods which are non invasive, accurate and with good trending ability, which can be used in a clinical setting. The aim of this study was to compare the Pressure Recording Analytical Method (PRAM) with the pulmonary artery thermodilution (TD) for the measurement of cardiac output in 6 anaesthetized critically ill dogs. Fifty-four pairs of CO measurements were obtained with a median (range) of 3.33 L/min (0.81-7.21) for PRAM-CO and 3.48 L/min (1.41-6.56) for TD-CO. The Bland-Altman analysis showed a mean bias of 0.17 L/min with limits of agreement (LoA) of - 0.46 to 0.81 L/min. The percentage error resulted 18.2%. The 4-quadrant plot analysis showed an acceptable concordance (93%) between the 2 methods. The polar plot showed a good trending ability with the mean angular bias of 3.9° and radial LoA ± 12.1°. The PRAM resulted in good precision, acceptable concordance and good trending ability for the measure of CO in the anaesthetized dog, representing a promising alternative to thermodilution for the measurement of CO. Among all the pulse contour methods available on the market it is the only one that does not require any calibration or adjustment of the measurement. Further studies are required to verify the ability of this method to accurately measure cardiac output even during unstable hemodynamic conditions.
Hincker, Alexander; Ben Abdallah, Arbi; Avidan, Michael; Candelario, Penka; Helsten, Daniel
Perioperative antibiotics decrease rates of surgical-site infections. Numerous interventions have improved administration of the first antibiotic dose; however, failures in the administration of subsequent doses frequently occur. We hypothesized that modifications to the electronic medical record (EMR) would improve the administration of the second antibiotic dose and that such improvements would be sustained over time. This historical cohort before-and-after study of multipronged alerts in the EMR analyzed 1,348 operations on adult patients. The operations lasted ≥ 240 min, utilized cefazolin as the perioperative antibiotic-constituting 1,348 second and 182 third intraoperative antibiotic doses-and did not involve cardiopulmonary bypass. A decision support intervention provided dosing recommendations when clinicians documented antibiotics. The reminder intervention displayed a continuous bar in the EMR, starting at the time the antibiotics were dosed and ending 15 min before subsequent doses were indicated. The primary endpoints of the study were the change in the proportion of correctly administered second dose of cefazolin, given in accordance with hospital guidelines in the month after implementing the intervention, and whether any improvements declined by three to seven months after implementation. Pre-intervention, 51.4% of second doses of cefazolin were correctly administered. In the immediate post-intervention period, 68.5% were correctly administered, representing a significant absolute improvement of 17.1% (95% confidence interval, 8.1 to 26.1; P pre-intervention). These inexpensive nonintrusive interventions to the EMR provided modest lasting improvements in proper administration of repeated doses of cefazolin. The fact that only approximately 70% compliance was reached highlights the difficulty in addressing this deficiency.
U.S. Environmental Protection Agency — All Federal Agencies are required to prescribe an appropriate records maintenance program so that complete records are filed or otherwise preserved, records can be...
Despins, Laurel A; Wakefield, Bonnie J
Failure to detect patient deterioration signals leads to longer stays in the hospital, worse functional outcomes, and higher hospital mortality rates. Surveillance, including ongoing acquisition, interpretation, and synthesis of patient data by the nurse, is essential for early risk detection. Electronic medical records promote accessibility and retrievability of patient data and can support patient surveillance. A secondary analysis was performed on interview data from 24 intensive care unit nurses, collected in a study that examined factors influencing nurse responses to alarms. Six themes describing nurses' use of electronic medical record information to understand the patients' norm and seven themes describing electronic medical record design issues were identified. Further work is needed on electronic medical record design to integrate documentation and information presentation with the nursing workflow. Organizations should involve bedside nurses in the design of handoff formats that provide key information common to all intensive care unit patient populations, as well as population-specific information.
Barnett, Michael L; Mehrotra, Ateev
Objective To assess the short term association of inpatient implementation of electronic health records (EHRs) with patient outcomes of mortality, readmissions, and adverse safety events. Design Observational study with difference-in-differences analysis. Setting Medicare, 2011-12. Participants Patients admitted to 17 study hospitals with a verifiable “go live” date for implementation of inpatient EHRs during 2011-12, and 399 control hospitals in the same hospital referral region. Main outcome measures All cause readmission within 30 days of discharge, all cause mortality within 30 days of admission, and adverse safety events as defined by the patient safety for selected indicators (PSI)-90 composite measure among Medicare beneficiaries admitted to one of these hospitals 90 days before and 90 days after implementation of the EHRs (n=28 235 and 26 453 admissions), compared with the control group of all contemporaneous admissions to hospitals in the same hospital referral region (n=284 632 and 276 513 admissions). Analyses were adjusted for beneficiaries’ sociodemographic and clinical characteristics. Results Before and after implementation, characteristics of admissions were similar in both study and control hospitals. Among study hospitals, unadjusted 30 day mortality (6.74% to 7.15%, P=0.06) and adverse safety event rates (10.5 to 11.4 events per 1000 admissions, P=0.34) did not significantly change after implementation of EHRs. There was an unadjusted decrease in 30 day readmission rates, from 19.9% to 19.0% post-implementation (P=0.02). In difference-in-differences analysis, however, there was no significant change in any outcome between pre-implementation and post-implementation periods (all P≥0.13). Conclusions Despite concerns that implementation of EHRs might adversely impact patient care during the acute transition period, we found no overall negative association of such implementation on short term inpatient mortality, adverse safety
Bould, Helen; DeStavola, Bianca; Magnusson, Cecilia; Micali, Nadia; Dal, Henrik; Evans, Jonathan; Dalman, Christina; Lewis, Glyn
Clinical impression is that rates of eating disorders vary between schools; we are not aware of any previous research on this topic. We aimed to investigate whether rates of eating disorders in 16-20-year-old girls vary between upper secondary schools, and to test the hypothesis that school characteristics are associated with rates of eating disorders, even after accounting for characteristics of individual students. This multilevel longitudinal study made use of record-linkage data from Stockholm County, Sweden. Participants were 55 824 Swedish-born girls completing secondary education in 2001-10 at 409 schools. Outcome was any diagnosed eating disorder at 16-20 years, as defined by an ICD (9 or 10) or DSM-IV code, or inferred from an appointment at a specialist eating disorder clinic. Multilevel modelling was used to separate individual and school level effects. The Stockholm Regional Ethical Review Board approved the study. A 4·4% variation in incidence of eating disorders between schools was seen; after taking individual risk factors into account variation between schools was 2·9% (95% CI 1·5-5·0). Schools with a higher proportions of girls than boys had an increased incidence of eating disorders: for each 10% increase in the proportion of girls at a school, the odds ratio for eating disorders was 1·07 (95% CI 1·01-1·13, p=0·017). For each 10% increase in the proportion of parents with post-secondary education, the odds ratio for eating disorders was 1·14 (1·09-1·19, peating disorders. Incidence rates of eating disorders are higher in schools characterised by a high proportion of female students and of students with highly educated parents. To our knowledge, this is the first study to investigate whether rates of eating disorders vary between schools; however, use of registry data means that individuals who did not seek treatment would not have been studied. HB was supported by a Wellcome Trust Institutional Strategic Support Fund (via the
Nakagawa, Haruo; Kanda, Keiji
A national radiation dose registration system is proposed in this paper. In Japan, only one radiation dose registration system is partly effective. It is applied for workers in nuclear power plants which are under control of regulatory laws for nuclear reactors. The total system was proposed previously by the Committee for Compensation Claims of Nuclear Accidents. The reason for the delay in establishing a registration system for all radiation workers is supposedly a lack of effort to adjust differences among items in radiation protection laws and the promotion of public acceptance to atomic power. Items about dose recordings, record keeping and dose-record reporting in all of the radiation regulatory laws are compared to each other, and items were extracted for revision. (author)
White, Jordan; Anthony, David; WinklerPrins, Vince; Roskos, Steven
Medical students commonly encounter electronic medical records (EMRs) in their ambulatory family medicine clerkships, but how students interact with this technology varies tremendously and presents challenges to students and preceptors. Little research to date has evaluated the impact of EMRs on medical student education in the ambulatory setting; this three-institution study aimed to identify behaviors of ambulatory family medicine preceptors as they relate to EMRs and medical students. In 2015, the authors sent e-mails to ambulatory preceptors who in the preceding year had hosted medical students during family medicine clerkships, inviting them to participate in the survey, which asked questions about each preceptor's methods of using the EMR with medical students. Of 801 ambulatory preceptors, 265 (33%) responded. The vast majority of respondents used an EMR and provided students with access to it in some way, but only 62.2% (147/236) allowed students to write electronic notes. Of those who allowed students electronic access, one-third did so by logging students in under their own (the preceptor's) credentials, either by telling the students their log-in information (22/202; 10.9%) or by logging in the student without revealing their passwords (43/202; 21.3%). Ambulatory medical student training in the use of EMRs not only varies but also requires many preceptors to break rules for students to learn important documentation skills. Without changes to the policies surrounding student access to and use of EMRs, future physicians will enter residency without the training they need to appropriately document patient care.
Sinyor, Mark; Schaffer, Ayal; Remington, Gary
Suicide is an important cause of premature mortality in people suffering from schizophrenia. This study aimed to identify demographic, personal, and suicide-specific features that distinguish suicide in people with schizophrenia from those with another severe mental illness (bipolar disorder) and those with neither illness. We conducted a coroner's chart review for 2,886 suicide victims in Toronto from 1998 to 2010. Diagnoses were made based on coroner interviews with available informants including family members, acquaintances, the deceased's physician(s) and/or review of medical records. Of the total, 258 formed what we defined as the schizophrenia group (204 schizophrenia, 34 unspecified psychotic illness, and 20 schizoaffective disorder). Of the remainder, 169 had bipolar disorder, and 2,459 had neither illness. One-way analysis of variance (ANOVA) tests and χ² tests were conducted to examine differences between the groups. The group with schizophrenia was the youngest (mean age for schizophrenia, 41.0 years; bipolar disorder, 43.3 years; and neither, 47.7 years; P schizophrenia, 75.6%; bipolar disorder, 57.4%; and neither, 52.9%; P schizophrenia, 9.3%; bipolar disorder, 5.4%; and neither, 3.2%; P schizophrenia, 26.7%; bipolar disorder, 37.9%; and neither, 54.1%; P schizophrenia group was the most likely to use a violent cause of death, specifically by fall from a height or by jumping in front of a vehicle (schizophrenia, 81.4%; bipolar disorder, 58.0%; and neither, 73.1%; P suicide-related differences between suicide victims with and without schizophrenia. Notably, suicide in schizophrenia overall appears to be more illness driven and occurs by more violent means than in the bipolar disorder group or those with neither illness. © Copyright 2015 Physicians Postgraduate Press, Inc.
Shivananda, Sandesh; Twiss, Jennifer; El-Gouhary, Enas; El-Helou, Salhab; Williams, Connie; Murthy, Prashanth; Suresh, Gautham
To determine the feasibility of introducing video recording (VR) of neonatal resuscitation (NR) in a perinatal centre. This was a prospective cohort quality improvement study on preterm infants and their caregivers. Based on evidence and experience of other centers using VR intervention, a contextually relevant implementation and evaluation strategy was designed in the planning phase. The components of intervention were pre-resuscitation team huddle, VR of NR and video debriefing (VD), all occurring on the same day. Various domains of feasibility and sustainability as well as feasibility criteria were predefined. Data for analysis was collected using quantitative and qualitative methods. Seventy-one caregivers participated in VD of 14 NRs facilitated by six trained instructors. Ninety-one percent of caregivers perceived enhanced learning and patient safety and, 48 issues were identified related to policy, caregiver roles, and latent safety threats. Ninety percent of caregivers expressed their willingness to participate in VD activity and supported the idea of integrating it into a resuscitation team routine. Eighty-three percent and 50% of instructors expressed satisfaction with video review software and quality of audio VR. No issues about maintenance of infant or caregivers' confidentiality and erasure of videos were reported. Criteria for feasibility were met (refusal rate of 50% of occasions, and < 20% caregivers' perceiving a negative impact on team performance). Necessary adaptations to enhance sustainability were identified. VR of NR as a standard of care quality assurance activity to enhance caregivers' learning and create opportunities that improve patient safety is feasible. Despite its complexity with inherent challenges in implementation, the intervention was acceptable, implementable, and potentially sustainable with adaptations.
Full Text Available Abstract Background Coxibs are claimed to be cost-effective drugs and reduced prescription of gastroprotective agents is assumed to be one of their major benefits. Real life prescription of these drugs may be substantially different than that considered in pharmacoeconomic analyses or claimed by drug companies, yet. Our objective was to evaluate whether coxibs were associated with reduced prescription of gastro-protective agents (GPAs, specifically proton pump inhibitors, H2 blockers and misoprostol compared to non selective NSAIDs. Methods A record-linkage study was performed using 2001 outpatient prescription data from the province of Modena (about 632,000 inhabitants, in Northern Italy. Logistic regression was used to calculate the odds ratio of GPA prescription for coxib and non-selective NSAID adult users (> 14 years. Three categories of users were further investigated: "acute", "chronic and "incident or new". Main outcome measures were same-day co-prescription and 30 days prescription of GPAs in coxibs and non selective NSAIDs users. To limit selection bias, data were adjusted for age, sex, DDD of coxibs and non selective NSAIDs received during 2001, DDD of GPAs and (for non-incident users DDD of NSAIDs received during the previous 4 years Results Same day co-prescription rates were similar considering the overall population and "acute" users. Chronic coxibs users instead showed higher co-prescription rates than chronic NSAIDs users (OR = 1.2, p Conclusion Assumptions made in pharmacoeconomic analyses on coxibs (lower GPA prescription associated with coxibs use may be overly optimistic. Claims made through cost-effectiveness data should be carefully interpreted, and mechanisms for attributing drug prices revised accordingly.
Maguire, Aideen; French, Declan; O'Reilly, Dermot
Background Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. While most previous research has relied on conceptualised measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or ‘peacelines’) which can be used to accurately identify residential segregation. Methods We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health. Results Using multilevel logistic regression models, we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a ‘peaceline’ increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI 1.14 to 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI 1.32 to 1.48), even after adjustment for gender, age, conurbation, deprivation and crime. Conclusions Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation. PMID:26858342
Full Text Available Background The symptom of fatigue is one of the top five most frequently presented health complaints in primary care, yet it remains underexplored in the Canadian primary care context.Objective The objective of this study was to examine the prevalence and impact of patients presenting with fatigue in primary care, using the only known electronic database in Canada to capture patient-reported symptoms.Methods Data were extracted from the Deliver Primary Healthcare Information (DELPHI database, an electronic medical record database located in Ontario, Canada. Patients were identified using the International Classification of Primary Care, Revised Second Edition coding system. Two groups of patients (fatigue or non-fatigue symptom were followed for one year and compared. Both descriptive and multivariable analyses were conducted.Results A total of 103 fatigue symptom patients, and 103 non-fatigue symptom patients, were identified in the DELPHI database. The period prevalence of fatigue presentation was 8.2%, with the majority of patients being female and over 60 years of age. These patients experienced numerous co-occurring morbidities, in addition to the fatigue itself. During the one year follow-up period, fatigue symptom patients had significantly higher rates of subsequent visits (IRR = 1.19, p = 0.038 and investigations (IRR = 1.68, p < 0.001, and markedly high levels of referrals following their index visit.Conclusions This research used an electronic database to examine the symptom, fatigue. Using these data, fatigue symptom patients were found to have higher rates of health care utilisation, compared to non-fatigue symptom patients.
Bernasconi, C; König, P
To investigate the directionality of neural interactions as assessed by electrophysiology, we adapted methods of structural analysis from the field of econometrics. In particular, within the framework of autoregressive modelling of the data, we considered quantitative measures of linear relationship between multiple time series adopting the Wiener-Granger concept of causality. The techniques were evaluated with local field potential measurements from the cat visual system. Here, several issues had to be addressed. First, out of several statistical tests of the stationarity of local field potentials considered, those based on the Kolmogorov-Smirnov and on the reverse arrangement statistics proved to be most powerful. The application of those tests to the experimental data showed that the large part of the local field potentials can be considered stationary on a time scale of 1 s. Second, out of the several investigated methods for the determination of an optimal order of the autoregressive model, the Akaike Information Criterion had the most suitable properties. The identified order of the model, across different repetitions of the trials, was consistently 5-8. Third, although the individual segments of field potentials used for the analysis were relatively short, the methods of structural analysis applied produced reliable results, confirming findings of simulations of data with similar properties. Furthermore the features of the estimated models were consistent among trials, so that the analysis of average measures of interaction appears to be a viable approach to investigate the relationship between the recording sites. In summary, the statistical methods considered have proved to be suitable for the study of the directionality of neuronal interactions.
Shen, Jay J; Ginn, Gregory O
Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption. Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals in the United States. General ordinal logistic regression was used for data analysis with a three-level dependent variable to measure adoption, five independent variables to measure financial position, and 11 control variables to measure structure and environment. For 2006, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover was significantly and negatively associated with EHR adoption. For 2002, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover and higher equity multiplier were both significantly and negatively associated with EHR adoption. In addition, lower net days revenue in accounts receivable was significantly and positively associated with EHR adoption. For both the 2002 and 2006 control variables, human resource intensity and bed size were significant and positively related to adoption, and percentage Medicare patients and investor ownership were significant and negatively related to adoption. Financial position does relate to EHR adoption in mid-term and long-term planning.
Booth, Helen P; Khan, Omar; Fildes, Alison; Prevost, A Toby; Reddy, Marcus; Charlton, Judith; Gulliford, Martin C
This study aimed to use primary care electronic health records to evaluate the epidemiology of bariatric surgery in the UK. A cohort comprising all obese patients with a bariatric surgical procedure was drawn from the Clinical Practice Research Datalink (CPRD). Rates of bariatric surgery were estimated using the registered CPRD population as denominator. There were 3039 adult obese patients with first bariatric surgery procedures between 2002 and 2014, including laparoscopic adjustable gastric banding (LAGB), 1297; gastric bypass (GBP), 1265; and sleeve gastrectomy (SG), 477. Annual procedures increased from one in 2002 to a maximum of 525 in 2010. Intervention rates were greatest among those aged 35-54, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. The mean age and body mass index of participants increased, as did the proportion of men and proportion with diabetes. Between 2002 and 2006, LAGB accounted for >90 % of procedures; in 2014, GBP accounted for 52 % and SG 26 %. Among patients initially receiving LAGB, the rate of band removal was 1.6 (95 % confidence interval 1.3-2.0) per 100 patient years; the rate of a second procedure of a different type was 1.2 (0.9-1.5) per 100 patient years. Numbers of bariatric surgical procedures have increased with increasing use of GBP and SG. Rates of bariatric surgery per 100,000 population remain low and provide evidence of limited access to bariatric surgical procedures in relation to need.
Woodruff, F; Savin, S M; Douglas, R G
Deep Sea Drilling Project site 289 in the western equatorial Pacific has yielded an extremely detailed record of the carbon and oxygen isotopic changes in the Miocene deep ocean. The isotopic record reflects major changes in paleoclimate and paleoceanography, probably dominated by a major phase of Antarctic ice-cap growth. The transition from a relatively unglaciated world to one similar to today occurred between 16.5 x 10(6) and 13 x 10(6) years before the present, with the greatest change occurring between approximately 14.8 x 10(6) and 14.0 x 10(6) years before the present.
Martínez-Matos, Óscar; Calvo, María L.; Rodrigo, José A.; Cheben, Pavel; del Monte, Francisco
We report results on the temporal evolution of the diffraction efficiency of volume holographic gratings recorded in a photopolymer glass incorporating Zr-based high refractive index species (HRIS) at molecular level. We record high spatial frequency gratings in this material with diffraction efficiencies near 100%. A two-component diffusion model is introduced for the evolution of refractive index modulation in darkness. Diffusion parameters for the Zr-based HRIS and monomer components have been determined. Codirectional diffusion of both components is demonstrated. The results show the feasibility for tailoring in this photomaterial holographic gratings with high diffraction efficiency over a wide range of spatial frequencies.
Full Text Available Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ referred to the emergency department (ED of Akdeniz hospital, Turkey, 2008. Demographic data, the season, place, reason, anatomical sites, total body surface area, degrees, proceeding treatment, and admission time were recorded. Multinomial logistic regression was used to compare frequencies’ differences among single categorized variables. Stepwise logistic regression was applied to develop a predictive model for hospitalization. P<0.05 was defined as a significant level. Results: Two hundred thirty patients were enrolled (53.9% female. The mean of patients' ages was 25.3 ± 22.3 years. The most prevalence of burn were in the 0-6 age group and most of which was hot liquid scalding (71.3%. The most affected parts of the body were the left and right upper extremities. With increasing the severity of triage level (OR=2.2; 95% CI: 1.02-4.66; p=0.046, intentional burn (OR=4.7; 95% CI: 1.03-21.8; p=0.047, referring from other hospitals or clinics (OR=3.4; 95% CI: 1.7-6.6; p=0.001, and percentage of burn (OR=18.1; 95% CI: 5.42-62.6; p<0.001 were independent predictive factor for hospitalization. In addition, odds of hospitalization was lower in patients older than 15 years (OR=0.7; 95% CI: 0.5-0.91; p=0.035. Conclusion: This study revealed the most frequent burns are encountered in the age group of 0-6 years, percentage of <10%, second degree, upper extremities, indoor, and scalding from hot liquids. Increasing ESI severity, intentional burn, referring from
Full Text Available Abstract Background Interoperable electronic health record (EHR solutions are currently being implemented in Canada, as in many other countries. Understanding EHR users’ perspectives is key to the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context the applicability, the importance, and the priority of pre-identified factors from a previous mixed-methods systematic review of international literature. Methods A three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (≥ 75% or moderate (≥ 60-74% according to user groups’ level of agreement on applicability and importance, partial (≥ 60% when participants agreed only on applicability or importance, or as no consensus ( Results Three Delphi rounds were completed by 64 participants. Levels of consensus of 100%, 64%, 64%, and 44% were attained on factors submitted to non-physician healthcare professionals, health information professionals, managers, and physicians, respectively. While agreement between and within user groups varied, key factors were prioritized if they were classified as strong (≥ 75% from questionnaire answers of user groups, for decision-making concerning EHR implementation. The10 factors that were prioritized are perceived usefulness, productivity, motivation, participation of end-users in the implementation strategy, patient and health professional interaction, lack of time and
Schneider, Hanna; Hill, Susan
Background Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objective This study set out to investigate patient families’ lived experiences of working with a PCEHR. Methods We conducted a semistructured qualitative field study with patient families and clinicians at a children’s hospital in the UK that uses a PCEHR (Patients Know Best). All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (eg, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach to avoidance oriented, and proposes that patients’ information needs depend on their style. Results We identified 3 groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach oriented, highly motivated to use PCEHR), and the 3 groups as collaborating (approach oriented, motivated to use PCEHR), cooperating (avoidance oriented, less motivated to use PCEHR), and avoiding (very avoidance oriented, not motivated to use PCEHR). Conclusions The PCEHR met the needs of controller and collaborators better than the needs of cooperators and avoiders. We draw on the Self-Determination Theory to propose ways in which a PCEHR design might better meet the needs of avoidance-oriented users. Further, we highlight the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control
Vandecasteele, Marie; M, S; Royer, Sébastien; Belluscio, Mariano; Berényi, Antal; Diba, Kamran; Fujisawa, Shigeyoshi; Grosmark, Andres; Mao, Dun; Mizuseki, Kenji; Patel, Jagdish; Stark, Eran; Sullivan, David; Watson, Brendon; Buzsáki, György
A major challenge in neuroscience is linking behavior to the collective activity of neural assemblies. Understanding of input-output relationships of neurons and circuits requires methods with the spatial selectivity and temporal resolution appropriate for mechanistic analysis of neural ensembles in the behaving animal, i.e. recording of representatively large samples of isolated single neurons. Ensemble monitoring of neuronal activity has progressed remarkably in the past decade in both small and large-brained animals, including human subjects. Multiple-site recording with silicon-based devices are particularly effective because of their scalability, small volume and geometric design. Here, we describe methods for recording multiple single neurons and local field potential in behaving rodents, using commercially available micro-machined silicon probes with custom-made accessory components. There are two basic options for interfacing silicon probes to preamplifiers: printed circuit boards and flexible cables. Probe supplying companies (http://www.neuronexustech.com/; http://www.sbmicrosystems.com/; http://www.acreo.se/) usually provide the bonding service and deliver probes bonded to printed circuit boards or flexible cables. Here, we describe the implantation of a 4-shank, 32-site probe attached to flexible polyimide cable, and mounted on a movable microdrive. Each step of the probe preparation, microdrive construction and surgery is illustrated so that the end user can easily replicate the process.
Adeyemi, Oluwakemi A.
The purpose of the exploratory qualitative study was to explore the strategies for reducing employee resistance to Electronic Medical Record (EMR) technology changes in a healthcare organization during implementation. The study focused on EPIC as the EMR application. Ten healthcare participants who had experienced a change to EMR were selected in…
... Privacy Act of 1974; System of Records--Study of Promising Features of Teacher Preparation Programs AGENCY... Teacher Preparation Programs'' (18-13-29). The National Center for Education Evaluation and Regional... Abt Associates to conduct a rigorous study of the effect on student learning of teachers who have...
Le Heuzey, Jean-Yves; Breithardt, Günter; Camm, John
The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation (RecordAF) is the first worldwide, 1-year observational, longitudinal study of the management of paroxysmal/persistent atrial fibrillation (AF) in recently diagnosed patients. The study was conducted at 532 sites...
Cooper, B. Lee; Cooper, Laura E.
Discusses popular music as a vehicle for cultural interchange between the United States and Great Britain between 1943 and 1967. Highlights include the early domination of U.S. record business interests and artistic styles established through the U.S. wartime and post-war military presence in England, and the later domination by British recording…
William Rainey Harper Coll., Palatine, IL. Office of Planning and Research.
In November 1985, a survey was conducted at William Rainey Harper College (WRHC), in Illinois, to test the feasibility of establishing programs for medical record technicians, medical coders, and utilization analysts. The survey instrument was mailed to 1,232 hospitals, medical care facilities, nursing homes, physicians' and dentists' offices, and…
Ghosh, A.K.; Rao, K.S.
Fourier spectra of 54 earthquake accelerograms recorded on rock sites in the U.S.A. have been analysed. These could be used in generation of synthetic accelerogramms for seismic design. (author). 19 figs., 1 tab., 1 appendix, 19 re fs
S. de Bie (Sandra); P.M. Coloma (Preciosa); C. Ferrajolo (Carmen); K.M.C. Verhamme (Katia); G. Trifirò (Gianluca); M.J. Schuemie (Martijn); S.M.J.M. Straus (Sabine); R. Gini (Rosa); R.M.C. Herings (Ron); G. Mazzaglia (Giampiero); G. Picelli (Gino); A. Ghirardi (Arianna); L. Pedersen (Lars); B.H.Ch. Stricker (Bruno); J. van der Lei (Johan); M.C.J.M. Sturkenboom (Miriam)
textabstractAim Electronic healthcare record (EHR)-based surveillance systems are increasingly being developed to support early detection of safety signals. It is unknown what the power of such a system is for surveillance among children and adolescents. In this paper we provide estimates of the
Background: Electronic health records (EHRs) are a ubiquitous component of the United States healthcare system and capture nearly all data collected in a clinic or hospital setting. EHR databases are attractive for secondary data analysis as they may contain detailed clinical rec...
Kidger, Judi; Gunnell, David; Jarvik, Jeffrey G.; Overstreet, Karen A.; Hollingworth, William
The associations between admissions to an emergency department following attempted suicide and personal bankruptcy in the preceding and subsequent 2 years were evaluated. Records from a level 1 trauma center (June 1993-December 2002) in Seattle, WA, were linked with case files from the local U.S. District Bankruptcy Court (June 1991 onward).…
Schreuder, Jolanda A. H.; Roelen, Corne A. M.; Van Zweeden, Nely F.; Jongsma, Dianne; Van der Klink, Jac J. L.; Groothoff, Johan W.
Aim To investigate nurse managers' leadership behaviour in relation to the sickness absence records of nursing staff. Background Sickness absence is high in healthcare and interferes with nursing efficiency and quality. Nurse managers' leadership behaviour may be associated with nursing staff
Road traffic and related noise is a major source of annoyance and impairment to health in urban areas. Many areas exposed to road traffic noise are also exposed to rail and air traffic noise. The resulting annoyance may depend on individual/neighborhood socio-demographic factors. Nevertheless, few studies have taken into account the confounding or modifying factors in the relationship between transportation noise and annoyance due to road traffic. In this study, we address these issues by combining Geographic Information Systems and epidemiologic methods. Street network buffers with a radius of 500 m were defined around the place of residence of the 7290 participants of the RECORD Cohort in Ile-de-France. Estimated outdoor traffic noise levels (road, rail, and air separately) were assessed at each place of residence and in each of these buffers. Higher levels of exposure to noise were documented in low educated neighborhoods. Multilevel logistic regression models documented positive associations between road traffic noise and annoyance due to road traffic, after adjusting for individual/neighborhood socioeconomic conditions. There was no evidence that the association was of different magnitude when noise was measured at the place of residence or in the residential neighborhood. However, the strength of the association between neighborhood noise exposure and annoyance increased when considering a higher percentile in the distribution of noise in each neighborhood. Road traffic noise estimated at the place of residence and road traffic noise in the residential neighborhood (75th percentile) were independently associated with annoyance, when adjusted for each other. Interactions of effects indicated that the relationship between road traffic noise exposure in the residential neighborhood and annoyance was stronger in affluent and high educated neighborhoods. Overall, our findings suggest that it is useful to take into account (i) the exposure to transportation noise
Laura J. Anzaldi
Full Text Available Abstract Background Geriatric syndromes, including frailty, are common in older adults and associated with adverse outcomes. We compared patients described in clinical notes as “frail” to other older adults with respect to geriatric syndrome burden and healthcare utilization. Methods We conducted a retrospective cohort study on 18,341 Medicare Advantage enrollees aged 65+ (members of a large nonprofit medical group in Massachusetts, analyzing up to three years of administrative claims and structured and unstructured electronic health record (EHR data. We determined the presence of ten geriatric syndromes (falls, malnutrition, dementia, severe urinary control issues, absence of fecal control, visual impairment, walking difficulty, pressure ulcers, lack of social support, and weight loss from claims and EHR data, and the presence of frailty descriptions in clinical notes with a pattern-matching natural language processing (NLP algorithm. Results Of the 18,341 patients, we found that 2202 (12% were described as “frail” in clinical notes. “Frail” patients were older (82.3 ± 6.8 vs 75.9 ± 5.9, p < .001 and had higher rates of healthcare utilization, including number of inpatient hospitalizations and emergency department visits, than the rest of the population (p < .001. “Frail” patients had on average 4.85 ± 1.72 of the ten geriatric syndromes studied, while non-frail patients had 2.35 ± 1.71 (p = .013. Falls, walking difficulty, malnutrition, weight loss, lack of social support and dementia were more highly correlated with frailty descriptions. The most common geriatric syndrome pattern among “frail” patients was a combination of walking difficulty, lack of social support, falls, and weight loss. Conclusions Patients identified as “frail” by providers in clinical notes have higher rates of healthcare utilization and more geriatric syndromes than other patients. Certain geriatric syndromes were more highly
Yamamoto, Keiichi; Matsumoto, Shigemi; Tada, Harue; Yanagihara, Kazuhiro; Teramukai, Satoshi; Takemura, Tadamasa; Fukushima, Masanori
In conventional clinical studies, the costs of data management for quality control tend to be high and collecting paper-based case report forms (CRFs) tends to be burdensome, because paper-based CRFs must be developed and filled out for each clinical study protocol. Use of electronic health records for this purpose could result in reductions in cost and improvements in data quality in clinical studies. The purpose of this study was to develop a data capture system for observational cancer clinical studies (i.e. outcomes studies) that would integrate with an electronic health records system, to enable evaluation of patient prognosis, prognostic factors, outcomes and drug safety. At the Outpatient Oncology Unit of Kyoto University Hospital, we developed a data capture system that includes a cancer clinical database system and a data warehouse for outcomes studies. We expect that our new system will reduce the costs of data management and analysis and improve the quality of data in clinical studies.
Full Text Available The term record group means a group of fonds (records and it is a type of archival fonds rarely described in Polish archival literature. Most often it is associated with the complex archival fonds, due to its comlicated structure and blurred borderlines – an effect of administrative system varying from the Polish one. The post-war attempts to modify and broaden the meaning of the complex fonds caused its resemblance to the term record group. Irena Radtke in her paper given during the 6th Archival Methods Conference in Warsaw in 1970 proposed, that the complex fonds should be one comprising records of foreign provenance that are an effect of passive succession. Bohdan Ryszewski, addressing Radtke’s idea, noticed that passive succession might be a source of complications. However, this conceptualization of the definition of the complex fonds did not correspond with the American understanding of it as an above-fonds structure.Bogdan Kroll has touched the core of the problem; he noticed that an archival construction comprising materials of various provenances cannot be seen neither as an archival fonds, nor as a complex fonds. He saw a discrepancy between the structure and partition of archival holdings and archival theory; thus Kroll proposed abandoning the term complex fonds and implementation of the term archival complex. The archival complex was supposed to be archival materials of various origins merged (in or outside of an archive into fonds, or parts of archival fonds of different institutions having the same characteristic – function. The complex was supposed to make up a separate entity in logic structure of archival holdings, comprising of all archival fonds and/or their pieces being parts of the main fonds of the complex. The problem of lack of above-fonds forms in the Polish archival theory has been also noticed by Józef Siemieński, who has formulated the term of higher-order fonds. According to his idea the higher
Katzenellenbogen Judy M
Full Text Available Abstract Background Measuring the real burden of cardiovascular disease in Australian Aboriginals is complicated by under-identification of Aboriginality in administrative health data collections. Accurate data is essential to measure Australia's progress in its efforts to intervene to improve health outcomes of Australian Aboriginals. We estimated the under-ascertainment of Aboriginal status in linked morbidity and mortality databases in patients hospitalised with cardiovascular disease. Methods Persons with public hospital admissions for cardiovascular disease in Western Australia during 2000-2005 (and their 20-year admission history or who subsequently died were identified from linkage data. The Aboriginal status flag in all records for a given individual was variously used to determine their ethnicity (index positive, and in all records both majority positive or ever positive and stratified by region, age and gender. The index admission was the baseline comparator. Results Index cases comprised 62,692 individuals who shared a total of 778,714 hospital admissions over 20 years, of which 19,809 subsequently died. There were 3,060 (4.9% persons identified as Aboriginal on index admission. An additional 83 (2.7% Aboriginal cases were identified through death records, increasing to 3.7% when cases with a positive Aboriginal identifier in the majority (≥50% of previous hospital admissions over twenty years were added and by 20.8% when those with a positive flag in any record over 20 years were incorporated. These results equated to underestimating Aboriginal status in unlinked index admission by 2.6%, 3.5% and 17.2%, respectively. Deaths classified as Aboriginal in official records would underestimate total Aboriginal deaths by 26.8% (95% Confidence Interval 24.1 to 29.6%. Conclusions Combining Aboriginal determinations in morbidity and official death records increases ascertainment of unlinked cardiovascular morbidity in Western Australian
Epstein, Barbara A; Tannery, Nancy H; Wessel, Charles B; Yarger, Frances; LaDue, John; Fiorillo, Anthony B
What is the process of developing a clinical information tool to be embedded in the electronic health record of a very large and diverse academic medical center? The development took place at the University of Pittsburgh Health Sciences Library System. The clinical information tool developed is a search box with subject tabs to provide quick access to designated full-text information resources. Each subject tab offers a federated search of a different pool of resources. Search results are organized "on the fly" into meaningful categories using clustering technology and are directly accessible from the results page. After more than a year of discussion and planning, a clinical information tool was embedded in the academic medical center's electronic health record. The library successfully developed a clinical information tool, called Clinical-e, for use at the point of care. Future development will refine the tool and evaluate its impact and effectiveness.
Xu, Hua; Jiang, Min; Oetjens, Matt; Bowton, Erica A; Ramirez, Andrea H; Jeff, Janina M; Basford, Melissa A; Pulley, Jill M; Cowan, James D; Wang, Xiaoming; Ritchie, Marylyn D; Masys, Daniel R; Roden, Dan M; Crawford, Dana C; Denny, Joshua C
DNA biobanks linked to comprehensive electronic health records systems are potentially powerful resources for pharmacogenetic studies. This study sought to develop natural-language-processing algorithms to extract drug-dose information from clinical text, and to assess the capabilities of such tools to automate the data-extraction process for pharmacogenetic studies. A manually validated warfarin pharmacogenetic study identified a cohort of 1125 patients with a stable warfarin dose, in which 776 patients were managed by Coumadin Clinic physicians, and the remaining 349 patients were managed by their providers. The authors developed two algorithms to extract weekly warfarin doses from both data sets: a regular expression-based program for semistructured Coumadin Clinic notes; and an advanced weekly dose calculator based on an existing medication information extraction system (MedEx) for narrative providers' notes. The authors then conducted an association analysis between an automatically extracted stable weekly dose of warfarin and four genetic variants of VKORC1 and CYP2C9 genes. The performance of the weekly dose-extraction program was evaluated by comparing it with a gold standard containing manually curated weekly doses. Precision, recall, F-measure, and overall accuracy were reported. Associations between known variants in VKORC1 and CYP2C9 and warfarin stable weekly dose were performed with linear regression adjusted for age, gender, and body mass index. The authors' evaluation showed that the MedEx-based system could determine patients' warfarin weekly doses with 99.7% recall, 90.8% precision, and 93.8% accuracy. Using the automatically extracted weekly doses of warfarin, the authors successfully replicated the previous known associations between warfarin stable dose and genetic variants in VKORC1 and CYP2C9.
Li, Shijin; Zhan, Di; Hu, Jinlong; Gao, Xiangtao; Bo, Ping
With the development of information technology, the digitization of scientific or engineering drawings has received more and more attention. In hydrology, meteorology, medicine and mining industry, the grid drawing sheet is commonly used to record the observations from sensors. However, these paper drawings may be destroyed and contaminated due to improper preservation or overuse. Further, it will be a heavy workload and prone to error if these data are manually transcripted into the computer. Hence, in order to digitize these drawings, establishing the corresponding data base will ensure the integrity of data and provide invaluable information for further research. This paper presents an automatic system for hydrological record image digitization, which consists of three key techniques, i.e., image segmentation, intersection point localization and distortion rectification. First, a novel approach to the binarization of the curves and grids in the water level sheet image has been proposed, which is based on the fusion of gradient and color information adaptively. Second, a fast search strategy for cross point location is invented and point-by-point processing is thus avoided, with the help of grid distribution information. And finally, we put forward a local rectification method through analyzing the central portions of the image and utilizing the domain knowledge of hydrology. The processing speed is accelerated, while the accuracy is still satisfying. Experiments on several real water level records show that our proposed techniques are effective and capable of recovering the hydrological observations accurately.
Full Text Available Abstract Background Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county. Methods Written records made by ambulance crews for patients (n = 397 who were not transported to hospital following an emergency call-out during October 2004 were retrospectively analysed. Results Twelve main themes emerged for RTT which included non injury or minor injury, falls and recovery after treatment on scene; other themes included alternative supervision, follow-up and treatment arrangements or patients arranging their own transport. Importantly, only 8% of the sample was recorded by ambulance crews as truly refusing to travel against advice. Conclusion A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. 'Refused to travel' disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services.
Comparing the Use of Books with Enhanced Records versus Those Without Enhancements: Methodology Leads to Questionable Conclusions. A review of: Madarash‐Hill, Cherie and J.B. Hill. “Electronically Enriched Enhancements in Catalog Records: A Use Study of Books Described on Records With URL Enhancements Versus Those Without.” Technical Services Quarterly 23.2 (2005): 19‐31.
Objective – To compare the use of books described by catalogue records that are enhanced with URL links to such information as dust jackets, tables of contents, sample text, and publishers’ descriptions, with the use of books described by records that are not enhanced with such links.Design – Use study.Setting – Academic library (Southeastern Louisiana University, Sims Memorial Library).Subjects – 180 records with enhancements and 180 records (different titles) without enhancements.Methods – ...
Al Shammary N
Full Text Available Nawaf Al Shammary,1 Koula Asimakopoulou,1 Fraser McDonald,2 Jonathon T Newton,1 Sasha Scambler1 1Division of Population and Patient Health, 2Craniofacial Development and Stem Cell Biology Department, King’s College London Dental Institute, London, UKBackground: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients’ medical records by orthodontists working in a large National Health Service (NHS London hospital.Materials and methods: A mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87 provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature.Results: The term “adherence” did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were “oral hygiene,” “appointment attendance” and “breakages of appliances.” Qualitative analysis not only confirmed these factors but also showed that 1 the clinical aspects of treatment, 2 clinician–patient interaction factors and 3 patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded.Conclusion: Adherence as a term does not feature in the clinical case notes of clinician-identified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency. Keywords: adherence, adults, orthodontic treatment
Zawiska, Izabela; Rzodkiewicz, Monika; Noryśkiewicz, Agnieszka; Kramkowski, Mateusz; Obremska, Milena; Ott, Florian; Plessen, Birgit; Tjallingii, Rik; Słowiński, Michał; Błaszkiewicz, Mirosław; Brauer, Achim
Lake sediments can be utilized as valuable paleoclimate and environmental archives as they contain information of past changes. Multi-proxy analyses of sedimentary compartments (e.g. pollen, diatoms, Cladocera) reveal those changes. However, to decipher the spatial variability of past climate changes and to define the proxies suited for local and regional scale reconstructions archive comparisons are needed. Here we present a detailed multi-proxy study from four different sediment cores covering the Younger Dryas cold period from the Lake Czechowskie region (N Poland). Three cores are located along a transect in the Lake Czechowskie basin from its deepest point towards a former lake bay close to today's shoreline. The fourth lacustrine sediment core was retrieved from the Trzechowskie paleolake, app. 1 km W from Lake Czechowskie. The dataset comprises information from pollen (AP, NAP, Juniperus, Betula-tree, Pinus silvestris), diatom (planktonic/benthic index, diatom valve concentration, dominant species), Cladocera (planktonic/benthic index, dominant species, number of Cladocera species, total sum of specimens) and geochemical (TOC and CaCO3 content, mineral matter, titanium) analyses. At the beginning of the Younger Dryas the AP pollen share decreased and NAP and Juniperus pollen increased in all studied locations. The mineral matter and titanium record showed higher values in two cores taken from the deepest parts of Lake Czechowskie and the core from Trzechowskie paleolake while in the core located at the marginal part of the lake it was already high in Allerød and it did not change much in Younger Dryas. The Cladocera based indexes: total sum of specimens and number of species decreased at the beginning of YD but on the contrary the Cladocera species composition changes were site-specific. The diatoms valve concentration index significantly lowered in core from the deep location while on the contrary increased in core from paleolake Trzechowskie. Our results
Carter, Stephen P.; Bearhop, Stuart; Harrison, Xavier A.; Dall, Sasha R. X.; McDonald, Robbie A.; Delahay, Richard J.
Knowledge of the way in which animals interact through social networks can help to address questions surrounding the ecological and evolutionary consequences of social organisation, and to understand and manage the spread of infectious diseases. Automated proximity loggers are increasingly being used to record interactions between animals, but the accuracy and reliability of the collected data remain largely un-assessed. Here we use laboratory and observational field data to assess the performance of these devices fitted to a herd of 32 beef cattle (Bos taurus) and nine groups of badgers (Meles meles, n = 77) living in the surrounding woods. The distances at which loggers detected each other were found to decrease over time, potentially related to diminishing battery power that may be a function of temperature. Loggers were highly accurate in recording the identification of contacted conspecifics, but less reliable at determining contact duration. There was a tendency for extended interactions to be recorded as a series of shorter contacts. We show how data can be manipulated to correct this discrepancy and accurately reflect observed interaction patterns by combining records between any two loggers that occur within a 1 to 2 minute amalgamation window, and then removing any remaining 1 second records. We make universally applicable recommendations for the effective use of proximity loggers, to improve the validity of data arising from future studies. PMID:22745704
Wang, Jian; Sun, Xiudong; Luo, Suhua; Jiang, Yongyuan
The dark enhancements with various exposure energies are studied in thick PQ/PMMA photopolymer. Considered the weak molecules diffusion of PQ component and the grating detuning, a new mechanism of dark reaction is proposed to explain the dark enhancement. Moreover, the influences of dark reaction on Bragg angular selectivity and grating recording are analyzed. The results are beneficial to the practical holography application.
Savenije, B; Lambooij, E; Pieterse, C; Korf, J
Electrical stunning in the process of slaughtering poultry is used to induce unconsciousness and immobilize the animal for easier processing. Unconsciousness is a function of brain damage. Brain damage has been studied with brain impedance recordings under ischemic conditions. This experiment
Sollie, Annet; Sijmons, Rolf H.; Helsper, Charles; Numans, Mattijs E.
Objectives To assess quality and reusability of coded cancer diagnoses in routine primary care data. To identify factors that influence data quality and areas for improvement. Methods A dynamic cohort study in a Dutch network database containing 250,000 anonymized electronic medical records (EMRs)
Rauscher, Kimberly J; Runyan, Carol W; Radisch, Deborah
Death certificates and medical examiner records have been useful yet imperfect data sources for work-related fatality research and surveillance among adult workers. It is unclear whether this holds for work-related fatalities among adolescent workers who suffer unique detection challenges in part because they are not often thought of as workers. This study investigated the utility of using these data sources for surveillance and research pertaining to adolescent work-related fatalities. Using the state of North Carolina as a case study, we analyzed data from the death certificates and medical examiner records of all work-related fatalities data among 11- to 17-year-olds between 1990-2008 (N = 31). We compared data sources on case identification, of completeness, and consistency information. Variables examined included those on the injury (e.g., means), occurrence (e.g., place), demographics, and employment (e.g., occupation). Medical examiner records (90%) were more likely than death certificates (71%) to identify adolescent work-related fatalities. Data completeness was generally high yet varied between sources. The most marked difference being that in medical examiner records, type of business/industry and occupation were complete in 72 and 67% of cases, respectively, while on the death certificates these fields were complete in 90 and 97% of cases, respectively. Taking the two sources together, each field was complete in upward of 94% of cases. Although completeness was high, data were not always of good quality and sometimes conflicted across sources. In many cases, the decedent's occupation was misclassified as "student" and their employer as "school" on the death certificate. Even though each source has its weaknesses, medical examiner records and death certificates, especially when used together, can be useful for conducting surveillance and research on adolescent work-related fatalities. However, extra care is needed by data recorders to ensure that
other medical and surgical procedures appear on the walls of Paleolithic caverns of Spain that date back to about 25,000 B.C.1 Although these archaic...record revealed that they were more careful in taking medications, made improvements in their diets , stopped smoking and had fewer worries about their...Pod 19 Mar TMC 3 30 Apr Surg 6 Apr RAH 29 Apr Eye 27 Apr Audio Cl 27 Apr Hosp 27 Nov Diet Cl 23 Apr F.P. 18 Apr Ortho/Pod 30 Apr Pod 26 Apr RAN 30 Apr
McInnes, E F; Scudamore, C L
Pathological evaluation of lesions caused directly by xenobiotic treatment must always take into account the recognition of background (incidental) findings. Background lesions can be congenital or hereditary, histological variations, changes related to trauma or normal aging and physiologic or hormonal changes. This review focuses on the importance and correct approach to recording of background changes and includes discussion on sources of variability in background changes, the correct use of terminology, the concept of thresholds, historical control data, diagnostic drift, blind reading of slides, scoring and artifacts. The review is illustrated with background lesions in Sprague Dawley and Wistar rats. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
The book discusses the theoretical path to decoding the information gathered from observations of old stellar systems. It focuses on old stellar systems because these are the fossil record of galaxy formation and provide invaluable information ont he evolution of cosmic structures and the universe as a whole. The aim is to present results obtained in the past few years for theoretical developments in low mass star research and in advances in our knowledge of the evolution of old stellar systems. A particularly representative case is the recent discovery of multiple stellar populations in galac
Soffin, E M; Emerson, R G; Cheng, J; Mercado, K; Smith, K; Beckman, J D
This is a pilot study to assess the clinical safety and efficacy of recording real-time flash visual evoked potentials (VEPs) using the SightSaver TM Visual Stimulator mask during prone spine surgery. A prospective, observational pilot study. Twenty patients presenting for spine surgery (microdiscectomy, 1-2 level lumbar fusion, or > 2 levels thoraco-lumbar fusion) were enrolled. The SightSaver™ Visual Stimulator™ was used to elicit VEPs throughout surgery. Somatosensory evoked potentials (SSEPs) were simultaneously recorded. All patients underwent general anesthesia with a combination of intravenous and inhaled agents. The presence, absence, and changes in VEP were qualitatively analyzed. Reproducible VEPs were elicited in 18/20 patients (36/40 eyes). VEPs were exquisitely sensitive to changes in anesthesia and decayed with rising MAC of isoflurane and/or N 2 O. Decrements in VEPs were observed without concomitant changes in SSEPs. The mask was simple to apply and use and was not associated with adverse effects. The SightSaver™ mask represents an emerging technology for monitoring developing visual insults during surgery. The definitive applications remain to be determined, but likely include use in select patients and/or surgeries. Here, we have validated the device as safe and effective, and show that VEPs can be recorded in real time under general anesthesia in the prone position. Future studies should be directed towards understanding the ideal anesthetic regimen to facilitate stable VEP recording during prone spine surgery.
McAlearney, Ann Scheck; Sieck, Cynthia; Hefner, Jennifer; Robbins, Julie; Huerta, Timothy R
Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during "go-live" and, subsequently, when users had more experience with the system. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.
Walsh, Kathleen E; Secor, Jessica L; Matsumura, Jon S; Schwarze, Margaret L; Potter, Beth E; Newcomer, Peter; Kim, Michael K; Bartels, Christie M
With increasing electronic health record (EHR) use, providers are talking less with one another. Now, many rely on EHRs, informal emails, or texts, introducing fragmentation and new data security challenges with new communication strategies. We aimed to examine the impact of a physician champion educational outreach intervention to promote electronic provider-to-provider communication in a large academic multispecialty group. Physician champions provided educational outreach to 16 academic departments, using 10-minute case-based presentations. Online surveys assessed communication preferences and practices. Electronic health record queries counted EHR messaging use before and after intervention. Descriptive statistics compared responses by specialty (z-test). Paired responses with pre-post data were compared using chi-square tests. Time series analysis assessed EHR messaging rates before intervention versus after intervention. Five hundred seventeen providers responded to the postoutreach survey. Eighty-six percent were familiar with EHR messaging tool and 78% knew how to use it after intervention. Among practitioner groups, Family Medicine preferred EHR messaging the most (62%). Groups who declined outreach least preferred it (26%). Among 88 respondents with paired pre-post intervention surveys, familiarity rose (79-96%), and self-reported use increased (66-88%). Physician champion educational outreach increased the use of the secure provider-to-provider EHR messaging tool.
Through the combination of manual retrieval and computerized retrieval, medical records of acupuncture-moxibustion in The Twenty-Four Histories were collected. Acupuncture cases from the Spring and Autumn Period (770-476 B.C.) to the end of the Ming Dynasty (1368-1644)were retrieved. From the medical records of acupuncture-moxibustion in Chinese official history books, it can be found that systematic diseases or emergent and severe diseases were already treated by physicians with the combination of acupuncture and medicine as early as in the Spring and Autumn Period as well as the Warring States Period(475-221 B.C.). CANG Gong, a famous physician of the Western Han Dynasty (206 B. C.-A. D. 24), cured diseases by selecting points along the running courses of meridians where the illness inhabited, which indicates that the theory of meridians and collaterals was served as a guide for clinical practice as early as in the Western Han Dynasty. Blood letting therapy, which has surprising effect, was often adopted by physicians of various historical periods to treat diseases. And treatment of diseases with single point was approved to be easy and effective.
Ann Scheck McAlearney
Full Text Available Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.
Stillová, K; Jurák, P; Chládek, J; Halámek, J; Telecká, S; Rektor, I
The objective is to study the involvement of the posterior medial cortex (PMC) in encoding and retrieval by visual and auditory memory processing. Intracerebral recordings were studied in two epilepsy-surgery candidates with depth electrodes implanted in the retrosplenial cingulate, precuneus, cuneus, lingual gyrus and hippocampus. We recorded the event-related potentials (ERP) evoked by visual and auditory memory encoding-retrieval tasks. In the hippocampus, ERP were elicited in the encoding and retrieval phases in the two modalities. In the PMC, ERP were recorded in both the encoding and the retrieval visual tasks; in the auditory modality, they were recorded in the retrieval task, but not in the encoding task. In conclusion, the PMC is modality dependent in memory processing. ERP is elicited by memory retrieval, but it is not elicited by auditory encoding memory processing in the PMC. The PMC appears to be involved not only in higher-order top-down cognitive activities but also in more basic, rather than bottom-up activities.
Kerr, Zachary; Evenson, Kelly R; Moore, Kari; Block, Richard; Diez Roux, Ana V
To explore the association of changes in perceived safety and police-recorded crime with changes in transport and leisure walking using longitudinal data from Chicago residents participating in the Multi-Ethnic Study of Atherosclerosis (2000-2012). Main exposures included perceived safety (self-reported as feeling safe walking in the neighborhood and reporting violence to be a problem in the neighborhood), and one-year counts of police-recorded crime occurring within a one-mile buffer of participants' residences. Main outcomes included transport and leisure walking (self-reported and calculated as total minutes/week across four study visits). Fixed effects models assessed the association of change in perceived safety and police-recorded crime with changes in transport and leisure walking over a 10-year period for 796 adults. No associations were found between changes in perceived safety and either changes in transport or leisure walking. Residing in areas with increases in murder was associated with decreases in transport walking. However, no other associations were found with police-recorded crime. There continues to be a need to explore the benefits of cultivating safe neighborhoods that enhance resident health and well-being. Research should continue examining how community initiatives may build safe environments and community identity that promote walking. Copyright © 2015 Elsevier Inc. All rights reserved.
Brian K Lee
Full Text Available BACKGROUND: Although screening for maternal red blood cell antibodies during pregnancy is a standard procedure, the prevalence and clinical consequences of non-anti-D immunization are poorly understood. The objective was to create a national database of maternal antibody screening results that can be linked with population health registers to create a research resource for investigating these issues. STUDY DESIGN AND METHODS: Each birth in the Swedish Medical Birth Register was uniquely identified and linked to the text stored in routine maternal antibody screening records in the time window from 9 months prior to 2 weeks after the delivery date. These text records were subjected to a computerized search for specific antibodies using regular expressions. To illustrate the research potential of the resulting database, selected antibody prevalence rates are presented as tables and figures, and the complete data (from more than 60 specific antibodies presented as online moving graphical displays. RESULTS: More than one million (1,191,761 births with valid screening information from 1982-2002 constitute the study population. Computerized coverage of screening increased steadily over time and varied by region as electronic records were adopted. To ensure data quality, we restricted analysis to birth records in areas and years with a sustained coverage of at least 80%, representing 920,903 births from 572,626 mothers in 17 of the 24 counties in Sweden. During the study period, non-anti-D and anti-D antibodies occurred in 76.8/10,000 and 14.1/10,000 pregnancies respectively, with marked differences between specific antibodies over time. CONCLUSION: This work demonstrates the feasibility of creating a nationally representative research database from the routine maternal antibody screening records from an extended calendar period. By linkage with population registers of maternal and child health, such data are a valuable resource for addressing important
Parker Gaddis, K L; Megonigal, J H; Clay, J S; Wolfe, C W
Ketosis is one of the most frequently reported metabolic health events in dairy herds. Several genetic analyses of ketosis in dairy cattle have been conducted; however, few have focused specifically on Jersey cattle. The objectives of this research included estimating variance components for susceptibility to ketosis and identification of genomic regions associated with ketosis in Jersey cattle. Voluntary producer-recorded health event data related to ketosis were available from Dairy Records Management Systems (Raleigh, NC). Standardization was implemented to account for the various acronyms used by producers to designate an incidence of ketosis. Events were restricted to the first reported incidence within 60 d after calving in first through fifth parities. After editing, there were a total of 42,233 records from 23,865 cows. A total of 1,750 genotyped animals were used for genomic analyses using 60,671 markers. Because of the binary nature of the trait, a threshold animal model was fitted using THRGIBBS1F90 (version 2.110) using only pedigree information, and genomic information was incorporated using a single-step genomic BLUP approach. Individual single nucleotide polymorphism (SNP) effects and the proportion of variance explained by 10-SNP windows were calculated using postGSf90 (version 1.38). Heritability of susceptibility to ketosis was 0.083 [standard deviation (SD) = 0.021] and 0.078 (SD = 0.018) in pedigree-based and genomic analyses, respectively. The marker with the largest associated effect was located on chromosome 10 at 66.3 Mbp. The 10-SNP window explaining the largest proportion of variance (0.70%) was located on chromosome 6 beginning at 56.1 Mbp. Gene Ontology (GO) and Medical Subject Heading (MeSH) enrichment analyses identified several overrepresented processes and terms related to immune function. Our results indicate that there is a genetic component related to ketosis susceptibility in Jersey cattle and, as such, genetic selection for
Yu, Ping; Qian, Siyu; Yu, Hui; Lei, Jianbo
Measuring the performance of electronic health records (EHR) is an important, yet un-resolved challenge. Various measurements have addressed different aspects of EHR success, yet a holistic, comprehensive measurement tool needs to be developed to capture the potential EHR success variables completely. A self-administered questionnaire survey instrument was developed based on the theoretical framework of the DeLone and McLean Information Systems Success Model. It measures nigh variables of EHR success: system quality, information quality, service quality, training, self efficacy, intention to use, use, user satisfaction and net benefits. The instrument was used to measure the performance of aged care EHR systems in three aged care organizations. The results suggest that the instrument was reliable.
Pavon-Carrasco, F.; Osete, M. L.; Martin-chivelet, J.; Egli, R.; Rossi, C.; Muñoz-García, B.; Heller, F.
Calcite speleothems, such as stalagmites and flowstones, have an enormous potential in palaeomagnetism, since they may grow continuously through thousands of years, the lock-in of remanent magnetisation is nearly instantaneous and ages of speleothems can be determined using high precision U-series radiometric dating techniques. However, the typically very low concentration of ferromagnetic minerals resulting in very weak natural remanent magnetisation (NRM) has limited their usage. In addition, secondary processes that could affect magnetization are poorly understood. Here we show results from a stalagmite from northern Spain (Cobre Cave) that recorded the Blake geomagnetic excursion. Two types of samples exhibiting different magnetic properties are observed. Isothermal remanent magnetisation (IRM) experiments indicate major contributions from low coercivity minerals in all samples. In white samples only ferrimagnetic minerals are detected whereas in light-brown samples variable amounts of high coercivity minerals can also be observed. The low coercivity IRM is thermally demagnetized at 550°C indicating the presence of magnetite. Maximum unblocking temperatures over 550°C of the high coercivity component suggest the additional presence of haematite in light-brown samples. Upon demagnetisation, all samples exhibited a directionally stable low-coercivity/low-unblocking temperature component that is considered as the characteristic remanent magnetisation (ChRM) carried by fine magnetite. The ChRM exhibited normal and reversed directions recording the Blake Geomagnetic Excursion which could be radiometrically dated between 116.5 ± 0.7 kyr BP and 112.0 ± 1.9 kyr BP. The second component carried by haematite has directions being always close to the present day field direction and is considered as a secondary component. Reliability of relative paleo-intensity (RPI) determinations is discussed.
Full Text Available Abstract Background Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes. Methods We constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006 - 31 March 2008 (N = 19,443. We systematically examined eight definitions for diabetes diagnosis, both established and proposed. Results The definition that identified the highest number of patients with diabetes (N = 2,180 while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75% and specificity (98%. Conclusions This study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.
Moch Fikriansyah Wicaksono
Full Text Available Record creation and management by individuals or organizations grows rapidly, particularly the change from print to electronics, and the smallest part of record (metadata. Therefore, there is a need to perform record management metadata, particularly for students who have the needs of recording references and citation. Reference management software (RMS is a software to help reference management, one of them named zotero. The purpose of this article is to describe the benefits of record management for the writing of scientific papers for students, especially on biology study program in UIN Malik Ibrahim Malang. The type of research used is descriptive with quantitative approach. To increase the depth of respondents' answers, we used additional data by conducting interviews. The selected population is 322 students, class of 2012 to 2014, using random sampling. The selection criteria were chosen because the introduction and use of reference management software, zotero have started since three years ago. Respondents in this study as many as 80 people, which is obtained from the formula Yamane. The results showed that 70% agreed that using reference management software saved time and energy in managing digital file metadata, 71% agreed that if digital metadata can be quickly stored into RMS, 65% agreed on the ease of storing metadata into the reference management software, 70% agreed when it was easy to configure metadata to quote and bibliography, 56.6% agreed that the metadata stored in reference management software could be edited, 73.8% agreed that using metadata will make it easier to write quotes and bibliography.
van Jaarsveld, Cornelia H M; Gulliford, Martin C
This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. Cohort study of primary care electronic health records. 375 general practices in England that contribute to the UK Clinical Practice Research Datalink. Individual participants were sampled if they were aged between 2 and 15 years during the period 1994-2013 and had one or more records of body mass index (BMI). Prevalence of overweight (including obesity) was defined as a BMI equal to or greater than the 85th centile of the 1990 UK reference population. Data were analysed for 370 544 children with 507 483 BMI records. From 1994 to 2003, the odds of overweight and obesity increased by 8.1% per year (95% CI 7.2% to 8.9%) compared with 0.4% (-0.2% to 1.1%) from 2004 to 2013. Trends were similar for boys and girls, but differed by age groups, with prevalence stabilising in 2004 to 2013 in the younger (2-10 year) but not older (11-15 year) age group, where rates continued to increase. Primary care electronic health records in England may provide a valuable resource for monitoring obesity trends. More than a third of UK children are overweight or obese, but the prevalence of overweight and obesity may have stabilised between 2004 and 2013. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
de Lange, G. J.; Versteegh, G.; Zonneveld, K. A. F.; Bernasconi, S. M.
For high-resolution paleoclimate studies on high-frequency variations, continuous marine records with sufficient time resolution are needed. Such records are rare but vital for our understanding of causes and consequences of climate and environmental change at decadal to millennial time scales. Our initial studies at a near-coastal and a deep Mediterranean anoxic basin site seem to provide a continuous marine paleo-climate record that permits such high-resolution and well dated climate reconstructions for at least the last few kyrs. Cores for the MOCCHA project have been collected during the pre-Moccha ESPRESSO cruise with RV Universitatis and CAPUCCINO cruise with RV Poseidon, followed by the DOPPIO cruise with RV Pelagia. The cores recovered and studied thusfar appear to contain largely laminated sediments (submillimetric) down to 10 kyr. We will introduce the sites with existing and recently published evidence and supplement these with preliminary results for both sites obtained during these cruises. All of these are illustrating their suitability for high-resolution studies of paleoclimate that we hope to extend to > 35 kyr, i.e. for future IODP drilling. This work is supported by the EUROMARGINS Programme of the European Science Foundation NWO.817.01.002 MOCCHA project).
Calisto, A; Bramanti, A; Galeano, M; Angileri, F; Campobello, G; Serrano, S; Azzerboni, B
The objective of this study is to investigate Id-iopatic Normal Pressure Hydrocephalus (INPH) through a multidimensional and multiparameter analysis of statistical data obtained from accurate analysis of Intracranial Pressure (ICP) recordings. Such a study could permit to detect new factors, correlated with therapeutic response, which are able to validate a predicting significance for infusion test. The algorithm developed by the authors computes 13 ICP parameter trends on each of the recording, afterward 9 statistical information from each trend is determined. All data are transferred to the datamining software WEKA. According to the exploited feature-selection techniques, the WEKA has revealed that the most significant statistical parameter is the maximum of Single-Wave-Amplitude: setting a 27 mmHg threshold leads to over 90% of correct classification.
Clelland, Sarah-Jane; Batt, Catherine M.
Lake sediments can play an important role in understanding and reconstructing temporal characteristics of the geomagnetic field, as they potentially offer near continuous high-resolution archives of magnetic information extending throughout the Holocene. To date lake sediment geomagnetic data has typically been excluded from British archaeomagnetic secular variation curves (SVC) due to uncertainties with the acquisition of magnetisation by lake sediments. This paper presents the argument that, with regards to British datasets, the real problem lies with poor chronological control and sets out to illustrate that with British archaeomagnetic data some progress has been made. The results indicate that it is not currently possible to resolve secular variation on a time scale of ˜100 years from published British lake sediment data but more success has been made with data from archaeological sediments. This level of detail has been considered necessary for the incorporation of lake sediment data into the British archaeomagnetic dataset, as the ability to resolve short-term geomagnetic changes is critical for the integration of any dataset into the British SVC. As the latter is predominantly employed to date archaeological architecture and artefacts requires that it has the ability to resolve changes over timescales relevant to human lifetimes. Using currently available data this retrospective critique confirms that, in archaeological sediments, depositional and thermoremanent magnetisation can record the same direction over the same time interval.
Georgeon, Larissa; Gorelick, Philip B; Raykov, Tenko; Farooq, Muhammad U; Min, Jiangyong; Goshgarian, Christopher; Haveman-Gould, Bradley; Groenhout, Amy; McCarthy, Molly
We carried out a quality improvement project utilizing the electronic medical record (EMR) to determine (1) the quality of vascular neurologists' recommendations for recurrent stroke prevention and (2) primary care provider (PCP) acknowledgement of the vascular neurologists' recurrent stroke prevention recommendations and their frequency of meeting the recommended metrics for risk factor control and lifestyle modification. We conducted a retrospective EMR chart review on a convenience sample of ischemic stroke patients during two epochs. Data collected included risk factors, stroke subtype, and process and outcome guidance metrics for recurrent ischemic stroke prevention according to American Heart Association/American Stroke Association (AHA/ASA) recommendations. Overall, vascular neurologists commonly recommended appropriate AHA/ASA risk factor management standards, but were less likely to do so for lifestyle management. Improvements in the EMR system over time, including the establishment of guideline-driven importable recurrent stroke prevention templates, led to a high frequency of proper risk factor and lifestyle recommendations made by vascular neurologists. Statistical analysis provided further evidence that the EMR positively influenced the delivery of proper recurrent stroke prevention guidance. Although PCPs infrequently acknowledged receipt of vascular neurology consultations, there was a relatively high frequency of achieved risk factor control. The latter may be attributed at least in part to pre-existent quality improvement programs implemented at primary care offices. Our exploratory findings suggest that proper use of the EMR may heighten efforts to provide appropriate and consistent recurrent stroke prevention recommendations in a primary care setting.
Namulanda, Gonza; Qualters, Judith; Vaidyanathan, Ambarish; Roberts, Eric; Richardson, Max; Fraser, Alicia; McVeigh, Katharine H; Patterson, Scott
Data from traditional public health surveillance systems can have some limitations, e.g., timeliness, geographic level, and amount of data accessible. Electronic health records (EHRs) could present an opportunity to supplement current sources of routinely collected surveillance data. The National Environmental Public Health Tracking Program (Tracking Program) sought to explore the use of EHRs for advancing environmental public health surveillance practices. The Tracking Program funded four state/local health departments to obtain and pilot the use of EHR data to address several issues including the challenges and technical requirements for accessing EHR data, and the core data elements required to integrate EHR data within their departments' Tracking Programs. The results of these pilot projects highlighted the potential of EHR data for public health surveillance of rare diseases that may lack comprehensive registries, and surveillance of prevalent health conditions or risk factors for health outcomes at a finer geographic level. EHRs therefore, may have potential to supplement traditional sources of public health surveillance data. Published by Elsevier Inc.
Tromp, M.; van Eijsden, M.; Ravelli, A. C. J.; Bonsel, G. J.
Selective non-response is an important threat to study validity as it can lead to selection bias. The Amsterdam Born Children and their Development study (ABCD-study) is a large cohort study addressing the relationship between life style, psychological conditions, nutrition and sociodemographic
Full Text Available Abstract Background A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients. Method We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness. Results Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category. Conclusions While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.
Carpentier, N; Jonas, J; Schaff, J-L; Koessler, L; Maillard, L; Vespignani, H
Home polysomnography is being increasingly developed for sleep studies, with various grades of quality. This study aimed to determine the feasibility of affordable, high quality home polysomnographic recordings prescribed for suspected sleep-related neurological disorders. We prospectively screened all patients referred to the specialist sleep disorders clinic in Nancy University Hospital between May 2011 and August 2011. Patients were eligible for inclusion if they required polysomnography for the diagnosis of a sleep-related neurological disorder. One-night, polysomnography was performed in each patient's home by a trained sleep technician. Financial cost was determined prior to inclusion. A recording was considered as satisfactory if all the following criteria were present: at least, one EEG channel with continuous signal allowing determination of sleep stages and wake during more than 66% of sleep time; at least, one usable respiratory channel (airflow or either band) during more than 66% of sleep time; and usable oximetry during more than 66% of sleep time. Forty-eight of the 139 screened patients were included. Among the 48 home polysomnography recordings, 35 (72.9%) were satisfactory. Thirteen (27.1%) tracings displayed an unsatisfactory loss of EEG data, including seven (14.6%) tracings with an unsatisfactory loss of respiratory data. Home polysomnography prescribed for suspected sleep-related neurological disorders is feasible, with affordable costs, whilst maintaining high quality recording. Further studies are needed to measure the real medico-economic impact of promoting outpatient domiciliary explorations for sleep-related neurological disorders. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Sami Farah Al-Rawas
Full Text Available Objectives: A measure to increase the electroencephalogram (EEG outcome includes a short period of nap sleep during a routine standard EEG with the aim of increasing its sensitivity to interictal abnormalities or provoking seizures. As part of an ongoing auditing of our EEG data, we aimed to investigate the contribution of nap sleep during routine outpatient department based EEGs requested for a variety of reasons. Methods: EEG data at the Department of Clinical Physiology at Sultan Qaboos University Hospital, Oman, from July 2006 to December 2007 and from January 2009 to December 2010 (total 42 months were reviewed. The EEGs were for patients older than 13-years referred for possible epilepsy, blackouts, headache, head trauma, and other non-specified attacks. The recording period was between 20 to 40 minutes. Abnormalities were identified during waking and nap sleep periods. Results: A total of 2 547 EEGs were reviewed and 744 were abnormal (29.2%. Of those abnormal EEGs, nap sleep was obtained in 258 (34.7% EEGs, and 39 (15.1% showed abnormalities during nap sleep. Nineteen out of the 39 (48.7% EEGs were abnormal during awake and nap sleep; and 20 (51.3% were abnormal during nap sleep, which represented only 2.7% of the total abnormal EEGs (n = 744. Conclusions: The contribution of the short nap sleep to the pickup rate of interictal abnormalities in EEG was minimal. We recommend the EEG service to include one cycle of spontaneous sleep EEG directed at patients with a history suggestive of epilepsy if their awake EEGs are normal.
Al-Rawas, Sami Farah; Abdelbasit, Khidir M; Al-Lawati, Huda Hussain; Poothrikovil, Rajesh; Al-Rawahi, Amal Khalfan; Khan, Abdul Aleem; Delamont, Robert Shane
A measure to increase the electroencephalogram (EEG) outcome includes a short period of nap sleep during a routine standard EEG with the aim of increasing its sensitivity to interictal abnormalities or provoking seizures. As part of an ongoing auditing of our EEG data, we aimed to investigate the contribution of nap sleep during routine outpatient department based EEGs requested for a variety of reasons. EEG data at the Department of Clinical Physiology at Sultan Qaboos University Hospital, Oman, from July 2006 to December 2007 and from January 2009 to December 2010 (total 42 months) were reviewed. The EEGs were for patients older than 13-years referred for possible epilepsy, blackouts, headache, head trauma, and other non-specified attacks. The recording period was between 20 to 40 minutes. Abnormalities were identified during waking and nap sleep periods. A total of 2 547 EEGs were reviewed and 744 were abnormal (29.2%). Of those abnormal EEGs, nap sleep was obtained in 258 (34.7%) EEGs, and 39 (15.1%) showed abnormalities during nap sleep. Nineteen out of the 39 (48.7%) EEGs were abnormal during awake and nap sleep; and 20 (51.3%) were abnormal during nap sleep, which represented only 2.7% of the total abnormal EEGs (n = 744). The contribution of the short nap sleep to the pickup rate of interictal abnormalities in EEG was minimal. We recommend the EEG service to include one cycle of spontaneous sleep EEG directed at patients with a history suggestive of epilepsy if their awake EEGs are normal.
Full Text Available Uncovering the functional properties of individual synaptic inputs on single neurons is critical for understanding the computational role of synapses and dendrites. Previous studies combined whole-cell patch recording to load neurons with a fluorescent calcium indicator and two-photon imaging to map subcellular changes in fluorescence upon sensory stimulation. By hyperpolarizing the neuron below spike threshold, the patch electrode ensured that changes in fluorescence associated with synaptic events were isolated from those caused by back-propagating action potentials. This technique holds promise for determining whether the existence of unique cortical feature maps across different species may be associated with distinct wiring diagrams. However, the use of whole-cell patch for mapping inputs on dendrites is challenging in large mammals, due to brain pulsations and the accumulation of fluorescent dye in the extracellular milieu. Alternatively, sharp intracellular electrodes have been used to label neurons with fluorescent dyes, but the current passing capabilities of these high impedance electrodes may be insufficient to prevent spiking. In this study, we tested whether sharp electrode recording is suitable for mapping functional inputs on dendrites in the cat visual cortex. We compared three different strategies for suppressing visually evoked spikes: (1 hyperpolarization by intracellular current injection, (2 pharmacological blockade of voltage-gated sodium channels by intracellular QX-314, and (3 GABA iontophoresis from a perisomatic electrode glued to the intracellular electrode. We found that functional inputs on dendrites could be successfully imaged using all three strategies. However, the best method for preventing spikes was GABA iontophoresis with low currents (5 to 10 nA, which minimally affected the local circuit. Our methods advance the possibility of determining functional connectivity in preparations where whole-cell patch may be
Roumeliotis, Nadia; Parisien, Geneviève; Charette, Sylvie; Arpin, Elizabeth; Brunet, Fabrice; Jouvet, Philippe
To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records. A prospective, observational, time-motion study. A level 3 PICU. Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008-2009) and after (2016) implementation of reorganization of care in 2013. The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare). Time spent completing various work tasks was recorded by direct observation, and proportion of time in tasks was compared for each study period. A total of 153.7 hours was observed from 22 nurses and 14 orderlies. There was no significant difference in the proportion of nursing patient care time before (68.8% [interquartile range, 48-72%]) and after (55% [interquartile range, 51-57%]) (p = 0.11) the reorganization with electronic medical record. Direct patient care task time for nurses was increased from 27.0% (interquartile range, 30-37%) before to 34.7% (interquartile range, 33-75%) (p = 0.336) after, and indirect patient care tasks decreased from 33.6% (interquartile range, 23-41%) to 18.6% (interquartile range, 16-22%) (p = 0.036). Documentation time significantly increased from 14.5% (interquartile range, 12-22%) to 26.2% (interquartile range, 23-28%) (p = 0.032). Nursing productivity ratio improved from 28.3 to 26.0. A survey revealed that nursing staff was satisfied with the electronic medical record, although there was a concern for the maintenance of oral communication in the unit. The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly
van Weel Chris
Full Text Available Abstract Background Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to show areas where potential improvements could be implemented. Methods We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded. Results We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241. A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death. Conclusions Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice.
Tavakoli, Nahid; Isfahani, Sakineh Saghaeiannejad; Piri, Zakiye; Amini, Afsaneh
The e-health system must have the capability of patient access to electronic health record. The advantage of access to their record lets them have better understanding of their condition and treatment. It can also raise the reliability of consistency and correctness of data in health care system. Finally it will improve the maintenance quality of medical records and guarantee better results of medication. This study aimed to carry out a comparative study concerning laws, policies and procedures upon patients' access right to EHR in selected countries and to suggest appropriate solutions for Iran. This was a comparative descriptive study. The study population was the laws, policies and procedures of patients' access right to EHR belong to countries like Canada, Australia, New Zealand and Iran. Data were collected by taking notes on index cards. In this study in order to collect data, at first, the researcher studied the websites related to Health Ministry of the countries and existing laws and policies through related links in the websites. In next step, the health information management association websites were studied and the related data were collected. The gathered data were analyzed through content analysis. The findings of research showed that in every four countries there are generally some laws, policies and procedures. Although Canada and New Zealand concerning the number of laws and policies related to the subject subsequently are ranked after Australia, they are ranked prior to Australia regarding benefiting the laws and specified policies. Given the necessity of EHR implementing and codifying the planning of SEPAS in Iran, as there is no specified laws or procedures regarding patients' access right to EHR, the obligation of paying attention to assigning a law or at least obvious policies and procedures and providing the details is absolutely apparent.
Full Text Available Timely pathology results are critical for appropriate diagnosis and management of patients. Yet workflows in laboratories remain ad hoc and involve accessing multiple systems with no direct linkage between patient history and prior or pending pathology records for the case being analyzed. A major hindrance in timely reporting of pathology results is the need to incorporate/interface with multiple electronic health records (EHRs. We evaluated the Illuminate PatientView software (Illuminate integration into pathologist's workflow. Illuminate is a search engine architecture that has a repository of textual information from many hospital systems. Our goal was to develop a comprehensive, user friendly patient summary display to integrate the current fractionated subspecialty specific systems. An analytical time study noting changes in turnaround time (TAT before and after Illuminate implementation was recorded for reviewers, including pathologists, residents and fellows. Reviewers' TAT for 359 cases was recorded (200 cases before and 159 after implementation. The impact of implementing Illuminate on transcriptionists’ workflow was also studied. Average TAT to retrieve EHRs prior to Illuminate was 5:32 min (range 1:35-10:50. That time was significantly reduced to 35 seconds (range 10 sec-1:10 min using Illuminate. Reviewers were very pleased with the ease in accessing information and in eliminating the draft paper documents of the pathology reports, eliminating up to 65 min/day (25-65 min by transcriptionists matching requisition with paperwork. Utilizing Illuminate improved workflow, decreased TAT and minimized cost. Patient care can be improved through a comprehensive patient management system that facilitates communications between isolated information systems.
Chromá, Kateřina; Brázdil, Rudolf; Valášek, Hubert; Zahradníček, Pavel
Meteorological and hydrological extremes (MHEs) cause great material damage or even loss of human lives in the present time, similarly as it was in the past. In the Czech Lands (recently the Czech Republic), systematic meteorological and hydrological observations started generally in the latter half of the 19th century. Therefore, in order to create long-term series of such extremes, it is necessary to search for other sources of information. Different types of documentary evidence are used in historical climatology and hydrology to find such information. Some of them are related to records connected with taxation system. The taxation system in Moravia allowed farmers to request tax relief if their crops have been damaged by MHEs. The corresponding documents contain information about the type of extreme event and the date of its occurrence; often also impacts on crops or land may be derived. The nature of events leading to damage include particularly hailstorms, torrential rain, flash floods, floods (in regions along larger rivers), less frequently windstorms, late frosts and in some cases also information about droughts or extreme snow depths. However, the results obtained are influenced by uncertainties related to taxation records - their temporal and spatial incompleteness, limitation of the MHEs occurrence in the period of main agricultural work (May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about MHEs was of secondary importance). All these aspects related to the study of MHEs from taxation records are demonstrated for five estates (Bítov, Budkov, Jemnice with Staré Hobzí, Nové Syrovice and Uherčice) in the south-western part of Moravia for the 18th-19th centuries. The analysis shows importance of taxation records for the study of past MHEs as well as great potential for their use.
White, Hollie; Bordo, Miguel; Chen, Sean
Written as a case study, this article outlines Duke Law School Information Services' video digitization, preservation, and access initiative. This article begins with a discussion of the case study environment and the cross-departmental evaluation of in-house video production and processing workflows. The in-house preservation reformatting process…
This study investigates designing and implementing a speaking course in which face-to-face instruction informed by the principles of Task-Based Learning is blended with the use of technology, the video, for the first-year student teachers of English in Turkish higher education. The study consisted of three hours of task-based classroom…
Peng, G.; Meier, W. N.; Scott, D. J.; Savoie, M. H.
A long-term, consistent, and reproducible satellite-based passive microwave sea ice concentration climate data record (CDR) is available for climate studies, monitoring, and model validation with an initial operation capability (IOC). The daily and monthly sea ice concentration data are on the National Snow and Ice Data Center (NSIDC) polar stereographic grid with nominal 25 km × 25 km grid cells in both the Southern and Northern Hemisphere polar regions from 9 July 1987 to 31 December 2007. The data files are available in the NetCDF data format at http://nsidc.org/data/g02202.html and archived by the National Climatic Data Center (NCDC) of the National Oceanic and Atmospheric Administration (NOAA) under the satellite climate data record program (http://www.ncdc.noaa.gov/cdr/operationalcdrs.html). The description and basic characteristics of the NOAA/NSIDC passive microwave sea ice concentration CDR are presented here. The CDR provides similar spatial and temporal variability as the heritage products to the user communities with the additional documentation, traceability, and reproducibility that meet current standards and guidelines for climate data records. The data set, along with detailed data processing steps and error source information, can be found at http://dx.doi.org/10.7265/N5B56GN3.
Arbet, J. D.; Benbow, R. L.
This design note presents a study of the Procedures and Performance Program (PPP) effectiveness. The intent of the study is to determine manpower time savings and the improvements in job performance gained through PPP automated techniques. The discussion presents a synopsis of PPP capabilities and identifies potential users and associated applications, PPP effectiveness, and PPP applications to other simulation/training facilities. Appendix A provides a detailed description of each PPP capability.
Full Text Available Objective: To study the morbidity pattern and relationship of these morbidities with socio-economic and demographic factors. Material and method: Present study was conducted at the Saraswathi Institute of Medical Sciences,Hapur,(U.P. among pregnant patients during the study period of one year. Data were analyzed using SPSS 16, using tabulation with percentage and Pearson's chi-square test was used for testing the crude associations. Results: In the present study a total of 338 pregnant women were included for the study material, out of which 67.46% of the antenatal women reported illness during antenatal period and majority 277(81.95% of the pregnant women were anemic.Thecommon non-obstetric morbidities reported were gastrointestinal disorder (24.68%, genital tuberculosis (16.88%, renal & gall bladder disease (7.79% and congenital anomaly (6.49% ect. (ii The obstetric morbidities included were pre-eclampsia(14.56%, urinary tract infection(9.71%, rupture of membrane(8.74%,hyperemesis gravidarum(9.22%and abnormal presentation in (2.43%patients . Conclusion: Maternal morbidity is notably high, although most of the common problems were not life-threatening. They are more likely to have marked influence on their wellbeing and health status in the long run. Most conditions could be addressed through provision of health promotion and preventive interventions.
Barufaldi, Laura Augusta; Abreu, Gabriela de Azevedo; Veiga, Gloria Valeria da; Sichieri, Rosely; Kuschnir, Maria Cristina Caetano; Cunha, Diana Barbosa; Pereira, Rosângela Alves; Bloch, Katia Vergetti
The Study of Cardiovascular Risk in Adolescents (ERICA) is a national multicenter study whose purpose is to describe the cardiovascular risk profile, including obesity, changes in lipid and glucose metabolism, and blood pressure, of about 75,000 Brazilian adolescents. To describe the development of a tool for data collection of 24-hour food recall (REC24h) in ERICA and to report its performance in the pilot study. The Multiple Pass Method was used for the development of the computer program that guides REC24h interview. REC24h-ERICA uses a database composed of 1,626 food items including preparation methods and units of predefined portion sizes. Food consumption data are obtained through interviews and entered directly into REC24h-ERICA, avoiding the use of paper. The pilot study included 1,367 adolescents, of which 1,047 (77%) responded to REC24h. The researchers did not report difficulties in program use, the average duration of interviews was 20 minutes and the interviewers inserted 50 new food items. The program developed was proven suitable for use in large-population studies, even in a country like Brazil, where there is great diversity in eating habits.
Chreiteh, Shadi; Saadi, Dorthe Bodholt; Belhage, Bo
Traditionally, measurements of the oxygen saturation (SpO2) has been confound to the extremities. In this study, we therefore investigated the possibility for reliable estimation of clinically relevant SpO2 levels from photoplethysmography (PPG) obtained on the sternum of patients with obstructive...... airway diseases. We initiated the study with a calibration of a prototype sternal PPG sensor. In accordance with the ISO 80601-2-61:2011 guidelines, the calibration was conducted as a controlled desaturation study. We obtained a calibration accuracy of 1.75% which is well within the clinically...... and commercially accepted range. We then compared the SpO2 levels simultaneously obtained from the sternal PPGs and a commercially available finger pulse oximeter on 28 admitted patients with either asthma or Chronic Obstructive Pulmonary Disease (COPD). The Pearson correlation between the SpO2 levels estimated...
Handel Adam E
Full Text Available Abstract Background Venous thromboembolism (VTE is a common complication during and after a hospital admission. Although it is mainly considered a complication of surgery, it often occurs in people who have not undergone surgery, with recent evidence suggesting that immune-mediated diseases may play a role in VTE risk. We, therefore, decided to study the risk of deep vein thrombosis (DVT and pulmonary embolism (PE in people admitted to hospital with a range of immune-mediated diseases. Methods We analysed databases of linked statistical records of hospital admissions and death certificates for the Oxford Record Linkage Study area (ORLS1:1968 to 1998 and ORLS2:1999 to 2008 and the whole of England (1999 to 2008. Rate ratios for VTE were determined, comparing immune-mediated disease cohorts with comparison cohorts. Results Significantly elevated risks of VTE were found, in all three populations studied, in people with a hospital record of admission for autoimmune haemolytic anaemia, chronic active hepatitis, dermatomyositis/polymyositis, type 1 diabetes mellitus, multiple sclerosis, myasthenia gravis, myxoedema, pemphigus/pemphigoid, polyarteritis nodosa, psoriasis, rheumatoid arthritis, Sjogren's syndrome, and systemic lupus erythematosus. Rate ratios were considerably higher for some of these diseases than others: for example, for systemic lupus erythematosus the rate ratios were 3.61 (2.36 to 5.31 in the ORLS1 population, 4.60 (3.19 to 6.43 in ORLS2 and 3.71 (3.43 to 4.02 in the England dataset. Conclusions People admitted to hospital with immune-mediated diseases may be at an increased risk of subsequent VTE. Our findings need independent confirmation or refutation; but, if confirmed, there may be a role for thromboprophylaxis in some patients with these diseases.
Brázdil, Rudolf; Valášek, Hubert; Chromá, Kateřina; Dolák, Lukáš; Řezníčková, Ladislava; Dobrovolný, Petr
The taxation system in Moravia allowed farmers to request tax relief if their crop yields had been negatively affected by hydrometeorological extremes. Firstly, the owners of land or individual farmers sent basic information about what had taken place, together with a detailed description of the damage, to the state executive (regional offices). After this, commissioners appointed by the regional administrator were obliged to inspect the places affected personally (in situ) and make records. Finally, the state executive made its decision as to whether to allow or reject the tax relief requested. The whole process was reflected in various surviving archival documents which contain information about the type of extreme event and the date of its occurrence, while the impact on crops may often be derived. Taxation documents of 201 estates in Southern Moravia, Czech Republic, prevailingly located in Moravian Land Archives in Brno, were studied to find information about hydrometeorological extremes. Such information is included for 84 of them. These data covering mainly the 18th-19th centuries were used for the study of historical floods (flash floods) complemented by other documentary sources and systematic hydrological observations (water stages, discharges) in the instrumental period (from the 1880s). Obtained flood data are analysed with respect to their temporal (frequency, seasonality) and spatial changes. Finally, uncertainties related to taxation records, such as their temporal and spatial incompleteness, the limits of the period of outside agricultural work (i.e. mainly May-August) and the purpose for which they were originally collected (primarily tax alleviation, i.e. information about hydrometeorological extremes was of secondary importance) are discussed with respect to results obtained. Taxation records constitute an important source of data for the study of historical floods with a great potential to be used in many European countries.
Baines, Rebecca; Langelaan, Maaike; de Bruijne, Martine; Spreeuwenberg, Peter; Wagner, Cordula
To assess whether, compared with previous years, hospital care became safer in 2011/2012, expressing itself in a fall in preventable adverse event (AE) rates alongside patient safety initiatives. Retrospective patient record review at three points in time. In three national AE studies, patient records of 2004, 2008 and 2011/2012 were reviewed in, respectively, 21 hospitals in 2004, 20 hospitals in 2008 and 20 hospitals in 2011/2012. In each hospital, 400, 200 and 200 patient records were sampled, respectively. In total, 15 997 patient admissions were included in the study, 7926 patient admissions from 2004, 4023 from 2008 and 4048 from 2011/2012. The main patient safety initiatives in hospital care at a national level between 2004 and 2012 have been small as well as large-scale multifaceted programmes. Rates of both AEs and preventable AEs. Uncorrected crude overall AE rates showed no change in 2011/2012 in comparison with 2008, whereas preventable AE rates showed a reduction of 45%. After multilevel corrections, the decrease in preventable AE rate in 2011/2012 was still clearly visible with a decrease of 30% in comparison to 2008 (p=0.10). In 2011/2012, fewer preventable AEs were found in older age groups, or related to the surgical process, in comparison with 2008. Our study shows some improvements in preventable AEs in the areas that were addressed during the comprehensive national safety programme. There are signs that such a programme has a positive impact on patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Vasan, Senthil K; Rostgaard, Klaus; Ullum, Henrik; Melbye, Mads; Hjalgrim, Henrik; Edgren, Gustaf
Background Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail. Methods We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden...
Ruether J Dean
Full Text Available Abstract Background The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. Methods Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. Discussion Consultation
Le Heuzey, Jean-Yves; Breithardt, Günter; Camm, John
in 21 countries across Europe, America, and Asia; recruitment was completed in April 2008. The primary objectives were to prospectively assess the therapeutic success and clinical outcomes in rhythm- and rate-control strategies. The study design and patient baseline data are reported. A total of 5......The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation (RecordAF) is the first worldwide, 1-year observational, longitudinal study of the management of paroxysmal/persistent atrial fibrillation (AF) in recently diagnosed patients. The study was conducted at 532 sites......,814 patients with AF were registered, and 5,604 were eligible for evaluation. Rhythm- and rate-control strategies were applied to 55% and 45% of patients, respectively, at study inclusion. Rhythm-control patients mainly received class III agents (45%) or beta blockers (51%), except for sotalol, and rate...
Draper, G.J.; Little, M.P.; Sorahan, T.
The objectives of this study were to test the 'Gardner hypothesis' that childhood leukaemia and non-Hodgkin lymphoma can be caused by paternal exposure to ionising radiation before the conception of the child, and more generally, to investigate whether such radiation exposure of either parent is a cause of childhood cancer. This was a case-control study, conducted in Great Britain, that involved 35,949 children diagnosed as having cancer, together with matched controls. Examination was made of: parental employment as radiation worker as defined by inclusion in the National Registry for Radiation Workers and being monitored for external radiation before conception of child; cumulative dose of external ionising radiation for various periods of employment before conception; pregnancy dose. It is concluded that the results do not support the hypothesis that paternal preconception irradiation is a cause of childhood leukaemia and non-Hodgkin lymphoma; the observed associations may be chance or result from exposure to infective or other agents. If there is any increased risk for the children of fathers who are radiation workers it is small in absolute terms: in Britain the average risk by age 15 years is 6.5 per 10,000; our best estimate, using all available data, is that the increase is 5.4 per 10,000. For mothers, the numbers are too small for reliable estimates of the risk, if any, to be made. (author)
Vasan, Senthil K; Rostgaard, Klaus; Ullum, Henrik; Melbye, Mads; Hjalgrim, Henrik; Edgren, Gustaf
Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail. We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models. Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98), compared to those with blood group O. Our results provide no evidence that ABO blood group influences the risk of dementia.
Pandey, Chhavi P.
Wavelet analysis is a powerful mathematical and computational tool to study periodic phenomena in time series particu-larly in the presence of potential frequency changes in time. Continuous wavelet transformation (CWT) provides localised spectral information of the analysed dataset and in particular useful to study multiscale, nonstationary processes occurring over finite spatial and temporal domains. In the present work, oxygen-isotope ratio from the plantonic foraminifera species (viz. Globigerina bul-loides and Globigerinoides ruber) acquired from the broad central plateau of the Maldives ridge situated in south-eastern Arabian sea have been used as climate proxy. CWT of the time series generated using both the biofacies indicate spectro-temporal varia-tion of the natural climatic cycles. The dominant period resembles to the period of Milankovitch glacial-interglacial cycle. Apart from that, various other cycles are present in the time series. The results are in good agreement with the astronomical theory of paleoclimates and can provide better visualisation of Indian summer monsoon in the context of climate change.
Panagiotis C. Pelekis,; Savvaidis, Alexandros; Kayen, Robert E.; Vlachakis, Vasileios S.; Athanasopoulos, George A.
Surface wave method was used for the estimation of Vs vs depth profile at 10 strong motion stations in Greece. The dispersion data were obtained by SASW method, utilizing a pair of electromechanical harmonic-wave source (shakers) or a random source (drop weight). In this study, three inversion techniques were used a) a recently proposed Simplified Inversion Method (SIM), b) an inversion technique based on a neighborhood algorithm (NA) which allows the incorporation of a priori information regarding the subsurface structure parameters, and c) Occam's inversion algorithm. For each site constant value of Poisson's ratio was assumed (ν=0.4) since the objective of the current study is the comparison of the three inversion schemes regardless the uncertainties resulting due to the lack of geotechnical data. A penalty function was introduced to quantify the deviations of the derived Vs profiles. The Vs models are compared as of Vs(z), Vs30 and EC8 soil category, in order to show the insignificance of the existing variations. The comparison results showed that the average variation of SIM profiles is 9% and 4.9% comparing with NA and Occam's profiles respectively whilst the average difference of Vs30 values obtained from SIM is 7.4% and 5.0% compared with NA and Occam's.
Full Text Available Abstract Background Aim of the study was to assess QTc interval by a 24-hour ECG recording in a group of HIV-infected individuals with a basal prolonged QTc. The risk factors associated with QTc prolongation and the indices of cardiovascular autonomic control were also evaluated. Methods A case–control study was performed using as cases 32 HIV-infected patients with prolonged (>440 msec QTc interval as assessed by Holter ECG, and as controls 64 HIV-infected subjects with normal QTc interval. Autonomic function was evaluated by heart rate variability analysis during 24-hour recording. Results Duration of HIV disease was significantly longer among cases than among controls (p=0.04. Waist/hip ratio was also higher among cases than among controls (p=0.05. Frequency domain analysis showed the absence of physiologic decrease of low frequency (LF in the night period in both cases and controls. The LF night in cases showed a statistically significant reduction when compared with controls (p=0.007. Conclusions In our study group, QTc interval prolongation was associated with a longer duration of HIV infection and with a greater waist/hip ratio. HIV patients with QTc interval prolongation and with a longer duration of HIV infection were more likely to have an impairment of parasympathetic and sympathetic cardiac component.
Hall, Dorothy K.; Comiso, Josefino C.; Shuman, Christopher A.; Koenig, Lora S.; DiGirolamo, Nicolo E.
Enhanced melting of the Greenland Ice Sheet has been documented in recent literature along with surface-temperature increases measured using infrared satellite data since 1981. Using a recently-developed climate-quality data record, 11- and 12-year trends in the clear-sky ice-surface temperature (IST) of the Greenland Ice Sheet have been studied using the Moderate-Resolution Imaging Spectroradiometer (MODIS) IST product. Daily and monthly MODIS ISTs of the Greenland Ice Sheet beginning on 1 March 2000 and continuing through 31 December 2010 are now available at 6.25-km spatial resolution on a polar stereographic grid as described in Hall et al. (submitted). This record will be elevated in status to a climate-data record (CDR) when more years of data become available either from the MODIS on the Terra or Aqua satellites, or from the Visible Infrared Imager Radiometer Suite (VIIRS) to be launched in October 2011. Maps showing the maximum extent of melt for the entire ice sheet and for the six major drainage basins have been developed from the MODIS IST dataset. Twelve-year trends of the duration of the melt season on the ice sheet vary in different drainage basins with some basins melting progressively earlier over the course of the study period. Some (but not all) of the basins also show a progressively-longer duration of melt. IST 12-year trends are compared with in-situ data, and climate data from the Modern Era Retrospective-Analysis for Research and Applications (MERRA) Reanalysis.
Matthewman, Richard; Court, Richard W; Crawford, Ian A; Jones, Adrian P; Joy, Katherine H; Sephton, Mark A
The organic record of Earth older than ∼3.8 Ga has been effectively erased. Some insight is provided to us by meteorites as well as remote and direct observations of asteroids and comets left over from the formation of the Solar System. These primitive objects provide a record of early chemical evolution and a sample of material that has been delivered to Earth's surface throughout the past 4.5 billion years. Yet an effective chronicle of organic evolution on all Solar System objects, including that on planetary surfaces, is more difficult to find. Fortunately, early Earth would not have been the only recipient of organic matter-containing objects in the early Solar System. For example, a recently proposed model suggests the possibility that volatiles, including organic material, remain archived in buried paleoregolith deposits intercalated with lava flows on the Moon. Where asteroids and comets allow the study of processes before planet formation, the lunar record could extend that chronicle to early biological evolution on the planets. In this study, we use selected free and polymeric organic materials to assess the hypothesis that organic matter can survive the effects of heating in the lunar regolith by overlying lava flows. Results indicate that the presence of lunar regolith simulant appears to promote polymerization and, therefore, preservation of organic matter. Once polymerized, the mineral-hosted newly formed organic network is relatively protected from further thermal degradation. Our findings reveal the thermal conditions under which preservation of organic matter on the Moon is viable.
Ravindrarajah, Rathi; Dregan, Alex; Hazra, Nisha C; Hamada, Shota; Jackson, Stephen H D; Gulliford, Martin C
Management of high blood pressure (BP) in people over 80 years is controversial, but there is limited information available concerning the uptake of hypertension treatment at this age. To evaluate use of antihypertensive drugs and changes in SBP and DBP from 2001 to 2014 in men and women aged 80 years and over. Cohort study using primary care electronic health records of 265 225 participants from the UK Clinical Practice Research Datalink. Records of BP and antihypertensive medications were analysed. Linear trends were estimated by frailty category in multiple regression models. Data were analysed for 116 401 men and 148 824 women. The proportion with BP recorded increased from 51% in 2001 to 78% in 2014. The proportion of patients prescribed antihypertensive medications increased from 64 to 76%. Mean SBP declined from 150 (SD 20) mmHg in 2001 to 135 (16) mmHg in 2014. In 'fit' participants, the decline in SBP was 12.4 (95% confidence interval 11.9-13.0) mmHg/decade in those treated for hypertension and 8.5 (7.8-9.1) mmHg in those not treated. The decline in SBP was smaller as frailty increased. The proportion of all participants with BP less than 140/90 mmHg increased from 14 to 44% in the study period. In octogenarians, BP treatment has intensified between 2001 and 2014. BP values have declined in both treated and untreated participants, with a substantial increase in the proportion achieving conventional BP targets.
Vasan, Senthil K; Rostgaard, Klaus; Ullum, Henrik
BACKGROUND: Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined...... the relationship between ABO blood group and dementia-related disorders in detail. METHODS: We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient...... and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models. RESULTS: Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3...
Full Text Available Global cesarean section (CS rates range from 1% to 52%, with a previous CS being the commonest indication. Labour following a previous CS carries risk of scar rupture, with potential for offspring hypoxic brain injury, leading to high rates of repeat elective CS. However, the effect of delivery by CS on long-term outcomes in children is unclear. Increasing evidence suggests that in avoiding exposure to maternal bowel flora during labour or vaginal birth, offspring delivered by CS may be adversely affected in terms of energy uptake from the gut and immune development, increasing obesity and asthma risks, respectively. This study aimed to address the evidence gap on long-term childhood outcomes following repeat CS by comparing adverse childhood health outcomes after (1 planned repeat CS and (2 unscheduled repeat CS with those that follow vaginal birth after CS (VBAC.A data-linkage cohort study was performed. All second-born, term, singleton offspring delivered between 1 January 1993 and 31 December 2007 in Scotland, UK, to women with a history of CS (n = 40,145 were followed up until 31 January 2015. Outcomes assessed included obesity at age 5 y, hospitalisation with asthma, learning disability, cerebral palsy, and death. Cox regression and binary logistic regression were used as appropriate to compare outcomes following planned repeat CS (n = 17,919 and unscheduled repeat CS (n = 8,847 with those following VBAC (n = 13,379. Risk of hospitalisation with asthma was greater following both unscheduled repeat CS (3.7% versus 3.3%, adjusted hazard ratio [HR] 1.18, 95% CI 1.05-1.33 and planned repeat CS (3.6% versus 3.3%, adjusted HR 1.24, 95% CI 1.09-1.42 compared with VBAC. Learning disability and death were more common following unscheduled repeat CS compared with VBAC (3.7% versus 2.3%, adjusted odds ratio 1.64, 95% CI 1.17-2.29, and 0.5% versus 0.4%, adjusted HR 1.50, 95% CI 1.00-2.25, respectively. Risk of obesity at age 5 y and risk of cerebral
Senthil K Vasan
Full Text Available Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail.We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models.Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98, compared to those with blood group O.Our results provide no evidence that ABO blood group influences the risk of dementia.
Vasan, Senthil K; Rostgaard, Klaus; Ullum, Henrik; Melbye, Mads; Hjalgrim, Henrik; Edgren, Gustaf
Background Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail. Methods We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models. Results Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer’s disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer’s disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98), compared to those with blood group O. Conclusions Our results provide no evidence that ABO blood group influences the risk of dementia. PMID:26042891
Kanady, Jennifer C; Drummond, Sean P A; Mednick, Sara C
This study aimed to determine if actigraphy could differentiate sleep and wake during a daytime nap and no-nap rest period. Fifty-seven subjects participated in the study; 30 subjects were in the nap group and the remaining 27 in the no-nap comparison group. All subjects wore actigraphs while simultaneously undergoing polysomnography (PSG). Three actigraphic sensitivity levels (high, medium, low) and two interval duration minimums (15 and 40 min) were used to score the nap and no-nap data. The variables examined included total sleep time (TST), sleep latency (SL), wake after sleep onset (WASO) and sleep efficiency (SE). The Bland-Altman technique was used to determine concordance. Epoch-by-epoch analysis examined actigraphic accuracy, sensitivity and specificity. For the naps, all actigraph settings except low-40 showed significant correlations with TST. The high and medium settings predicted SE significantly and the high settings predicted SL significantly. Bland-Altman analyses demonstrated high settings overestimated TST while high and medium settings overestimated SE. Overall, for the nap condition accuracy for the actigraph was 82-86%, sensitivity was 92-96% and specificity was 40-67%. In the no-nap condition, accuracy for the actigraph was 60-84%, sensitivity was 47-78% and specificity was 60-86%. Medium-40 and low-40 were the only settings that did not misidentify sleep in the no-nap condition. These results suggest that actigraphy can predict TST, SE and SL reliably, depending upon parameter settings, and actigraphy is a highly sensitive but not specific measure for daytime naps. Different actigraphy settings may be optimal depending upon the variables of interest. Discrimination of sleep and wake during periods of waking quiescence is not as robust as during periods of mainly daytime sleep. © 2010 European Sleep Research Society.
Pince, Ercag; Sabareesh, Sabareesh K. P.; Volpe, Giorgio; Gigan, Sylvain; Volpe, Giovanni S.
Particles undergoing a stochastic motion within a disordered medium is a ubiquitous physical and biological phenomenon. Examples can be given from organelles as molecular machines of cells performing physical tasks in a populated cytoplasm to human mobility in patchy environment at larger scales. Our recent results showed that it is possible to use the disordered landscape generated by speckle light fields to perform advanced manipulation tasks at the microscale. Here, we use speckle light fields to study the anomalous diffusion of micron size silica particles (5 μm) in the presence of active microswimmers. The microswimmers we used in the experiments are motile bacteria, Escherichia coli (E.coli). They constitute an active background constantly agitating passive silica particles within complex optical potentials. The speckle fields are generated by mode mixing inside a multimode optical fiber where a small amount of incident laser power (maximum power = 12 μW/μm2) is needed to obtain an effective random landscape pattern for the purpose of optical manipulation. We experimentally show how complex potentials contribute to the anomalous diffusion of silica particles undergoing collisions with swimming bacteria. We observed an enhanced diffusion of particles interacting with the active bath of E.coli inside speckle light fields: this effect can be tuned and controlled by varying the intensity and the statistical properties of the speckle pattern. Potentially, these results could be of interest for many technological applications, such as the manipulation of microparticles inside optically disordered media of biological interests.
Gardiner, Nicholas J; Hawkesworth, Chris J; Robb, Laurence J; Whitehouse, Martin J; Roberts, Nick M W; Kirkland, Christopher L; Evans, Noreen J
Granitoid-hosted mineral deposits are major global sources of a number of economically important metals. The fundamental controls on magma metal fertility are tectonic setting, the nature of source rocks, and magma differentiation. A clearer understanding of these petrogenetic processes has been forged through the accessory mineral zircon, which has considerable potential in metallogenic studies. We present an integrated zircon isotope (U-Pb, Lu-Hf, O) and trace element dataset from the paired Cu-Au (copper) and Sn-W (tin) magmatic belts in Myanmar. Copper arc zircons have juvenile εHf (+7.6 to +11.5) and mantle-like δ 18 O (5.2-5.5‰), whereas tin belt zircons have low εHf (-7 to -13) and heavier δ 18 O (6.2-7.7‰). Variations in zircon Hf and U/Yb reaffirm that tin belt magmas contain greater crustal contributions than copper arc rocks. Links between whole-rock Rb/Sr and zircon Eu/Eu* highlight that the latter can monitor magma fractionation in these systems. Zircon Ce/Ce* and Eu/Eu* are sensitive to redox and fractionation respectively, and here are used to evaluate zircon sensitivity to the metallogenic affinity of their host rock. Critical contents of Sn in granitic magmas, which may be required for the development of economic tin deposits, are marked by zircon Eu/Eu* values of ca. ≤0.08.
Gulliford, Martin C; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Charlton, Judith; Dregan, Alex
BACKGROUND: There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical
Rizzi, A.; Baratti, G.; Jiménez, B.; Girardi, S.; Remondino, F.
In the last years, thanks to the advances of surveying sensors and techniques, many heritage sites could be accurately replicated in digital form with very detailed and impressive results. The actual limits are mainly related to hardware capabilities, computation time and low performance of personal computer. Often, the produced models are not visible on a normal computer and the only solution to easily visualized them is offline using rendered videos. This kind of 3D representations is useful for digital conservation, divulgation purposes or virtual tourism where people can visit places otherwise closed for preservation or security reasons. But many more potentialities and possible applications are available using a 3D model. The problem is the ability to handle 3D data as without adequate knowledge this information is reduced to standard 2D data. This article presents some surveying and 3D modeling experiences within the APSAT project ("Ambiente e Paesaggi dei Siti d'Altura Trentini", i.e. Environment and Landscapes of Upland Sites in Trentino). APSAT is a multidisciplinary project funded by the Autonomous Province of Trento (Italy) with the aim documenting, surveying, studying, analysing and preserving mountainous and hill-top heritage sites located in the region. The project focuses on theoretical, methodological and technological aspects of the archaeological investigation of mountain landscape, considered as the product of sequences of settlements, parcelling-outs, communication networks, resources, and symbolic places. The mountain environment preserves better than others the traces of hunting and gathering, breeding, agricultural, metallurgical, symbolic activities characterised by different lengths and environmental impacts, from Prehistory to the Modern Period. Therefore the correct surveying and documentation of this heritage sites and material is very important. Within the project, the 3DOM unit of FBK is delivering all the surveying and 3D material to
Maria U. Kottwitz
Full Text Available Background: Although work absenteeism is in the focus of occupational health, longitudinal studies on organizational absenteeism records in hospital work are lacking. This longitudinal study tests time pressure and lack of time autonomy to be related to higher sickness absenteeism. Methods: Data was collected for 180 employees (45% nurses of a Swiss hospital at baseline and at follow-up after 1 year. Absent times (hours per month were received from the human resources department of the hospital. One-year follow-up of organizational absenteeism records were regressed on self-reported job satisfaction, time pressure, and time autonomy (i.e., control at baseline. Results: A multivariate regression showed significant prediction of absenteeism by time pressure at baseline and time autonomy, indicating that a stress process is involved in some sickness absenteeism behavior. Job satisfaction and the interaction of time pressure and time autonomy did not predict sickness absenteeism. Conclusion: Results confirmed time pressure and time autonomy as limiting factors in healthcare and a key target in work redesign. Keywords: healthcare, occupational health, time autonomy, work absenteeism, work stress
Full Text Available Aims: 1. To identify the extent of clinical gaps at the context of knowledge, practice and systems. 2. To formulate necessary intervention measures towards bridging the gaps. Settings and Design: Comparative, cross-sectional and non-interventional study. Methods and Material: It is retrospective, record-based study conducted upon inpatients (n = 200 of major disciplines of two teaching hospitals. Major outcome variables were to observe the matching and un-matching of final and provisional diagnosis by using ICD-10 criteria. Statistical Analysis Used: Comparative analysis of specific and selective gaps were estimated in terms of percentage (%. Results: Pilot observation showed the existence of gaps between provisional and final diagnosis in both private and government institution. Both knowledge and skill gaps were evident in caregivers and gap in documentation was existent in medical records. Conclusions: The pilot data is may be an eye-opener to public and private governance systems for understanding and revising the process service planning and service delivery. Necessary intervention measures may be contemplated towards enhancing diagnostic skill of doctors for quality hospital care.
Chatterjee, Sudeshna; Ray, Krishnangshu; Das, Anup Kumar
1. To identify the extent of clinical gaps at the context of knowledge, practice and systems. 2. To formulate necessary intervention measures towards bridging the gaps. Comparative, cross-sectional and non-interventional study. It is retrospective, record-based study conducted upon inpatients ( n = 200) of major disciplines of two teaching hospitals. Major outcome variables were to observe the matching and un-matching of final and provisional diagnosis by using ICD-10 criteria. Comparative analysis of specific and selective gaps were estimated in terms of percentage (%). Pilot observation showed the existence of gaps between provisional and final diagnosis in both private and government institution. Both knowledge and skill gaps were evident in caregivers and gap in documentation was existent in medical records. The pilot data is may be an eye-opener to public and private governance systems for understanding and revising the process service planning and service delivery. Necessary intervention measures may be contemplated towards enhancing diagnostic skill of doctors for quality hospital care.
Full Text Available In this paper we evalllate the seismic amplification effects in the town of Benevento llsing records of an explo- sion of 500 kg fired at abollt 7 km. Seismic records were obtained at 43 selected sites in the city by digital three-component stations. A data selection performed on the signal-to-noise ratio reduced the available data to 26 stations. We used the spectral ratio techniques to evaluate the amplification effects of each recording site compared both to the average spectrum calculated over 26 stations and to a reference seismic station. The shapes of the spectral ratios were classified according to the geological characteristics of the site. A characteristic shape of the spectral ratio was observed to be related to the specific structure of the subsoil. In particular, the sites on basin sediments (Lagonegro Unit and Middle Pleistocene conglomerates failed to show amplification effects; the sites on thick alluvial deposits showed amplification in the 5-9 Hz range; finally, sites on alluvial-lacustrine deposits amplified the seismic signal at frequencies depending on the characteristics and the thickness of the deposit. In addition, damage distribution caused by the 1688 earthquake in Benevento was related to the thickness of the surface layers in the ancient built-up area of the town. The study of the spectral ra- tios showed that these deposits amplify ground motion at frequencies between 9 and 12 Hz, i.e. frequencies close to the natural period of the most widespread buildings at that time in Benevento. Geological and seismic data were jointly used to carry out a zonation of the urban area of Benevento on the basis of homogeneous seismic responses. The validity of this analysis is limited to the main frequency band and amplitude of ground motion produced by the explosions.
Comparing the Use of Books with Enhanced Records versus Those Without Enhancements: Methodology Leads to Questionable Conclusions. A review of: Madarash‐Hill, Cherie and J.B. Hill. “Electronically Enriched Enhancements in Catalog Records: A Use Study of Books Described on Records With URL Enhancements Versus Those Without.” Technical Services Quarterly 23.2 (2005: 19‐31.
Full Text Available Objective – To compare the use of books described by catalogue records that are enhanced with URL links to such information as dust jackets, tables of contents, sample text, and publishers’ descriptions, with the use of books described by records that are not enhanced with such links.Design – Use study.Setting – Academic library (Southeastern Louisiana University, Sims Memorial Library.Subjects – 180 records with enhancements and 180 records (different titles without enhancements.Methods – The study identified the sample of unenhanced records by conducting searches of the broad subject terms “History”, “United States”, “Education”,and “Social” and limiting the searches to books. The enhanced sample was derived in the same manner, but with additional search limiters to identify only those records that had URL enhancements. An equal sample of enhanced and unenhanced records (50 or 30 of each was tracked for each of four search terms. Only records for books that could be checked out were included, as use statistics were based on whether or not a book was borrowed. While half of the enhanced records had full‐text elements (such as descriptions that were indexed and thus searchable, the rate of use for these records was not tracked separately from the enhanced records that only had URL enhancements.Main results – Books described on records with URL enhancements for publisher descriptions, tables of contents, book reviews, or sample text had higher use than those without URL enhancements. Only 7% of titles with URLs, compared with 21% of those without, had not been borrowed. 74.67% of titles with URLs had been checked out one or two times, compared with 69.5% of those without URLs. The number of titles with enhanced records that had 3 or more checkouts was almost double the rate of unenhanced titles (18% to 9.5%.Conclusion – The authors conclude that catalogue records that have electronic links to book reviews, cover
state. His provisional diagnosis is "Atypical Guillian Barre ." The initial assessment of Mr. Pratt reveals absence of all protective reflexes. His...Translocatlon Syndrome Fluid Volume Deficit, (Actual)(2) Verbal Communication, Impaired Nutrition, Alteration In: Potential for More...More Than Body Requirements, Comfort, Alteration In: Pain or Exogenous Obesity; Less Than Body Pain Self-Management Deficit Rape Trauma Syndrome
Puwar, Bhavna; Patel, Vaibhavi; Patel, Minal
Various socio demographic factors play role in sterilization operation. A record-based study was conducted in Jetalpur, rural area of Ahmedabad District. Records of all sterilization operation done between April 2010 to March 2011 were studied. A total of 180 sterilization operations were performed, of which 179 (99.4%) were female sterilization and one (0.6%) was vasectomy. The mean age of females was 28.27 years and that of their husbands was 31.72 years. Total 45% of females in the study population were illiterate, whereas 17% of their husbands were illiterate and their average family size was 2.8 members. Majority of females underwent sterilization operation when the age of last living child was between 1-5 years. In 67% cases, female health worker was the motivator. Only two couples had no living male child, whereas all other couples had at least one male child in the family. There was no significant relationship between the education of the mother and the age of the last living child, but education of mother was significantly related to the total number of living children in the family. Education of the father was significantly related with the age of last living child and the total number of living children in the family. The study reveals that education of both parents is an important driving factor in deciding the size of family. Majority of couple decide for permanent sterilization after having at least one male child. Thus, there is a strong preference for at least one male child in the family.
Full Text Available In this study which carried out on trees and shrubs in forest phytocoenose of Rize province, fifty-one microfungi species have been identified as new record for mycobiota of our country. Sixteen genera have been determined as new record on level of genera among these species.
G. W. L. Gresik
Full Text Available The goal of RECORDS (Reaching Recording Data Technologies is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.
Scantlebury, Arabella; Sheard, Laura; Watt, Ian; Cairns, Paul; Wright, John; Adamson, Joy
To explore the benefits, barriers and disadvantages of implementing an electronic record system (ERS). The extent that the system has become 'normalised' into routine practice was also explored. Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives of different grades, health care assistants) and wards within a maternity unit at a NHS teaching hospital. Interviews were conducted during the first year of the phased implementation of ERS and were analysed thematically. The four mechanisms of Normalisation Process Theory (NPT) (coherence, cognitive participation, collective action and reflexive monitoring) were adapted for use within the study and provided a theoretical framework to interpret the study's findings. Coherence (participants' understanding of why the ERS has been implemented) was mixed - whilst those involved in ERS implementation anticipated advantages such as improved access to information; the majority were unclear why the ERS was introduced. Participants' willingness to engage with and invest time into the ERS (cognitive participation) depended on the amount of training and support they received and their willingness to change from paper to electronic records. Collective action (the extent the ERS was used) may be influenced by whether participants perceived there to be benefits associated with the system. Whilst some individuals reported benefits such as improved legibility of records, others felt benefits were yet to emerge. The parallel use of paper and the lack of integration of electronic systems within and between the trust and other healthcare organisations hindered ERS use. When appraising the ERS (reflexive monitoring) participants perceived the system to negatively impact the patient-clinician relationship, time and patient safety. Despite expectations that the ERS would have a number of advantages, its implementation was perceived to have a range of
Shea Christopher M
Full Text Available Abstract Background Health information technology (HIT applications that incorporate point-of-care use of health-related quality of life (HRQL assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients. Methods Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff. Results The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1 duplicative of information gathered via other means during the encounter; (2 specific enough to be useful and/or acted upon, and; (3 useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information. Conclusions Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice
Ravindrarajah, Rathi; Hazra, Nisha C; Hamada, Shota; Charlton, Judith; Jackson, Stephen H D; Dregan, Alex; Gulliford, Martin C
Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportional-hazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life. © 2017 The Authors.
Hsu, Fang-Ming; Hu, Paul Jen-Hwa; Chen, Hsinchun; Hu, Han-Fen
While e-government is propelling and maturing steadily, advanced technological capabilities alone cannot guarantee agencies’ realizing the full benefits of the enabling computer-based systems. This study analyzes information systems in e-government settings by examining agencies’ satisfaction with an electronic record management system (ERMS). Specifically, we investigate key satisfaction determinants that include regulatory compliance, job relevance, and satisfaction with support services for using the ERMS. We test our model and the hypotheses in it, using a large-scale survey that involves a total of 1,652 government agencies in Taiwan. Our results show significant effects of regulatory compliance on job relevance and satisfaction with support services, which in turn determine government agencies’ satisfaction with an ERMS. Our data exhibit a reasonably good fit to our model, which can explain a significant portion of the variance in agencies’ satisfaction with an ERMS. Our findings have several important implications to research and practice, which are also discussed.
Hilden, Wolfgang; )
Preservation of RK and M starts in the pre-closure phase. A comprehensive waste inventory is required which needs to be maintained over significantly long time spans before RWM has reached the step of disposal. Since long term management solutions are often not clearly defined, disposal acceptance criteria are and cannot be known beforehand, at least not in early stages of disposal programs. Thus a Preservation of RK and M should therefore be approached within the rationale of life cycle analysis. There is a wide variety of approaches with regard to waste inventories at EU level, and retrieving data is often lengthy and difficult. The Commission dedicated a study to identify good practices and formulate recommendations. There are two main issues; firstly waste data collection, recording and reporting, and secondly record keeping and knowledge transfer. One concerns the present time, while the other is concerned with long periods of time. With regard to the analysis of data requirements, it was found that they depend on the context of their use, be it safe treatment, storage and disposal, policy making and capacity planning or funding. The study identifies for each use relevant data sets. Thus, the question of the purpose of RK and M preservation heavily influences the question of which records need to be maintained (cf. the RK and M Vision Document). This is also true with regard to the potential need to cope with changes of the regulatory system or overall RWM policy, which requires to preserve raw data in continuously accessible form. On the other hand the contextualization of data is needed, for which the safety case may be a useful tool. With regard to legacy waste, re-assessment or re-conditioning campaigns should aim at maximum information gain. Agreements on how to coherently account for the total volume of the waste need to be made. A balance needs to be found between completeness and overload (watch out for 'Keep everything, find nothing'). Data
Gold, Jonathan; Reyes-Gastelum, David; Turner, Jane; Davies, H Dele
Despite expert guidelines, gaps persist in quality of care for children with asthma. This study sought to identify barriers and potential interventions to improve compliance to national asthma prevention guidelines at a single academic pediatric primary care clinic. Using the plan-do-check-act (PDCA) quality improvement framework and fishbone analysis, several barriers to consistent asthma processes and possible interventions were identified by a group of key stakeholders. Two interventions were implemented using the electronic medical record (EMR). Physician documentation of asthma quality measures were analyzed before intervention and during 2 subsequent time points over 16 months. Documentation of asthma action plans (core group P PDCA and fishbone analysis in conjunction with embedded EMR tools can improve asthma care in a pediatric primary care setting.
Rao, Akhil Sanjay; Adam, Terrence J; Gensinger, Raymond; Westra, Bonnie L
The purpose of this study was to understand the factors which promoted the demand for iPads by physicians in two Emergency departments (ED) prior to a system wide implementation of an electronic medical record (EMR). A grounded theory design was employed and 14 semi-structured interviews conducted with ED physicians. Analysis of the interview transcripts was completed using Atlas.ti qualitative software, which revealed that physicians' perceptions of iPad use in the ED stemmed from their personal use of iPads along with three perceived ease of use factors. Physicians perceived that improved patient physician interaction, improved workflow and structural iPad benefits promoted their demand. Physicians perceived the structural benefits of iPads would improve patient physician interaction and improve workflow in the ED. As interest in handheld devices such as iPads increases, these findings could direct and encourage other iPad implementations at other hospital EDs'.
Xun, Xiaodong; Erwin, James K.; Bletscher, Warren; Choi, Jinhan; Kallenbach, Senta; Mansuripur, Masud
We present the results of crystallization studies in thin-film samples of amorphous and crystalline GexSbyTez. The experiments, conducted at moderately elevated temperatures, are based on measurements of the first-order diffraction efficiency from a two-dimensional periodic array of recorded marks. When the samples are slowly heated above room temperature, changes in the efficiencies of various diffracted orders give information about the on-going crystallization process within the sample. Two different compositions of the GeSbTe alloy are used in these experiments. Measurements on Ge2Sb2,3Te5 films show crystallization dominated by nucleation. For the Sb-rich eutectic composition Ge-(SbTe), crystallization is found to be dominated by growth from crystalline boundaries. We also show that crystalline marks written by relatively high-power laser pulses are different in their optical properties from the regions crystallized by slow heating of the sample to moderate temperatures.
Steven Goldfarb; Mitch McLachlan; Homer A. Neal
Web Archives of ATLAS Plenary Sessions, Workshops, Meetings, and Tutorials from 2005 until this past month are available via the University of Michigan portal here. Most recent additions include the Trigger-Aware Analysis Tutorial by Monika Wielers on March 23 and the ROOT Workshop held at CERN on March 26-27.Viewing requires a standard web browser with RealPlayer plug-in (included in most browsers automatically) and works on any major platform. Lectures can be viewed directly over the web or downloaded locally.In addition, you will find access to a variety of general tutorials and events via the portal.Feedback WelcomeOur group is making arrangements now to record plenary sessions, tutorials, and other important ATLAS events for 2007. Your suggestions for potential recording, as well as your feedback on existing archives is always welcome. Please contact us at firstname.lastname@example.org. Thank you.Enjoy the Lectures!
Tzoumakis, Stacy; Dean, Kimberlie; Green, Melissa J; Zheng, Catherine; Kariuki, Maina; Harris, Felicity; Carr, Vaughan J; Laurens, Kristin R
To examine the impact of parental criminal offending, both paternal and maternal, on offspring aggression at age 5 years, while also considering key risk factors, including parental mental illness, child's sex, and socioeconomic disadvantage. The sample comprised 69,116 children, with linked parental information, from the New South Wales Child Development Study, a population-based multi-agency, multi-generational record linkage study that combines information from a teacher-reported cross-sectional survey of early childhood development at age 5 years (the 2009 Australian Early Development Census; AEDC) with data obtained via administrative records from multiple sources (e.g., health, crime, education, and welfare). Hierarchical logistic regression analyses were conducted to determine the effects of maternal and paternal criminal court appearances (frequency and type of offending), and mental health service contacts, on offspring aggression measured in the AEDC. Having a parent with a history of offending was significantly associated with high levels of offspring aggression in early childhood. The strength of association was greatest when parents were involved in frequent (≥6 offences: adjusted odds ratio [aOR] range = 1.55-1.73) and violent (aOR range = 1.49-1.63) offending. Both maternal and paternal offending remained significant predictors of offspring aggression after accounting for parental mental illness, and associations were similar in magnitude for maternal and paternal offending histories. Parental history of severe criminal offending increased the risk of high levels of aggression in offspring during early childhood, highlighting the need for intervention with families during this key developmental period.
Marcos, Mar; Maldonado, Jose A; Martínez-Salvador, Begoña; Boscá, Diego; Robles, Montserrat
Clinical decision-support systems (CDSSs) comprise systems as diverse as sophisticated platforms to store and manage clinical data, tools to alert clinicians of problematic situations, or decision-making tools to assist clinicians. Irrespective of the kind of decision-support task CDSSs should be smoothly integrated within the clinical information system, interacting with other components, in particular with the electronic health record (EHR). However, despite decades of developments, most CDSSs lack interoperability features. We deal with the interoperability problem of CDSSs and EHRs by exploiting the dual-model methodology. This methodology distinguishes a reference model and archetypes. A reference model is represented by a stable and small object-oriented model that describes the generic properties of health record information. For their part, archetypes are reusable and domain-specific definitions of clinical concepts in the form of structured and constrained combinations of the entities of the reference model. We rely on archetypes to make the CDSS compatible with EHRs from different institutions. Concretely, we use archetypes for modelling the clinical concepts that the CDSS requires, in conjunction with a series of knowledge-intensive mappings relating the archetypes to the data sources (EHR and/or other archetypes) they depend on. We introduce a comprehensive approach, including a set of tools as well as methodological guidelines, to deal with the interoperability of CDSSs and EHRs based on archetypes. Archetypes are used to build a conceptual layer of the kind of a virtual health record (VHR) over the EHR whose contents need to be integrated and used in the CDSS, associating them with structural and terminology-based semantics. Subsequently, the archetypes are mapped to the EHR by means of an expressive mapping language and specific-purpose tools. We also describe a case study where the tools and methodology have been employed in a CDSS to support
Veena Kirthika S
Full Text Available Background: Assessment of motor function is a vital characteristic of infant development. Alberta Infant Motor scale (AIMS is considered to be one of the tool available for screening the developmental delays, but this scale was formulated by using western samples. Every country has its own ethnic and cultural background and various differences are observed in the culture and ethnicity. Therefore, there is a need to obtain reliability for the use of AIMS in south Indian population. Purpose: To find the intra-rater and inter-rater reliability of Alberta Infant Motor Scale (AIMS on pre-term infants using the recorded video observations in Indian population. Method: 30 preterm infants in three age groups, 0-3 months (10 infants, 4-7 months (10 infants, 8-18 months (10 infants were recruited for this reliability study. The AIMS was administered to the preterm infants and the performance was videotaped. The performance was then rescored by the same therapist, immediately from the video and on another two consecutive months to estimate intra-rater reliability using ICC (3,1, two-way mixed effects model. For reporting inter-rater reliability, AIMS was scored by three different raters, using ICC (2,k two-way random effects model and by two other therapists to examine the inter and intra-rater reliability. Results: The two-way mixed effects model for intra-rater reliability of AIMS, ICC (3,1 = 0.99 and for reporting inter-rater reliability of AIMS by two-way random effects model, ICC (2,k = 0.96. Conclusion: AIMS has excellent intra and inter-rater reliability using recorded video observations among the preterm infants in India
Aben, F. M.; Dekkers, M. J.; Bakker, R. R.; van Hinsbergen, D. J. J.; Zachariasse, W. J.; Tate, G. W.; McQuarrie, N.; Harris, R.; Duffy, B.
Inconsistent polarity patterns in sediments are a common problem in magnetostratigraphic and paleomagnetic research. Multiple magnetic mineral generations result in such remanence "haystacks." Here we test whether end-member modeling of isothermal remanent magnetization acquisition curves as a basis for an integrated rock magnetic and microscopic analysis is capable of isolating original magnetic polarity patterns. Uppermost Miocene-Pliocene deep-marine siliciclastics and limestones in East Timor, originally sampled to constrain the uplift history of the young Timor orogeny, serve as case study. An apparently straightforward polarity record was obtained that, however, proved impossible to reconcile with the associated biostratigraphy. Our analysis distinguished two magnetic end-members for each section, which result from various greigite suites and a detrital magnetite suite. The latter yields largely viscous remanence signals and is deemed unsuited. The greigite suites are late diagenetic in the Cailaco River section and early diagenetic, thus reliable, in the Viqueque Type section. By selecting reliable sample levels based on a quality index, a revised polarity pattern of the latter section is obtained: consistent with the biostratigraphy and unequivocally correlatable to the Geomagnetic Polarity Time Scale. Although the Cailaco River section lacks a reliable magnetostratigraphy, it does record a significant postremagnetization tectonic rotation. Our results shows that the application of well-designed rock magnetic research, based on the end-member model and integrated with microscopy and paleomagnetic data, can unravel complex and seemingly inconsistent polarity patterns. We recommend this approach to assess the veracity of the polarity of strata with complex magnetic mineralogy.
Saunders, M B; Gulabivala, K; Holt, R; Kahan, R S
The aim of this preliminary study was to test the reliability of radiographic evaluation of features of endodontic interest using a newly devised data collection system. Twelve endodontic MSc postgraduate students and one specialist endodontist examined sample radiographs derived from a random selection of 42 patients seen previously on an Endodontic New Patient Clinic (EDI). Each student examined a random selection of 8-9 roots on periapical radiographs of single- and multirooted teeth, with and without previous root canal therapy and 3-4 dental panoramic tomograms (DPTs). A total of 100 roots were examined. A proforma was used to record observations on 67 radiographic features using predefined criteria. Intra-observer agreement was tested by asking the students to re-examine the radiographs. The principle investigator and the specialist endodontist examined the same radiographs and devised a Gold Standard using the same criteria. This was compared with the student assessments to determine inter-observer variation. The postgraduates then attended a revision session on the use of the form. Each student subsequently examined 8-9 different roots from the pool of radiographs. A further assessment of inter-observer variation was made by comparing these observations with the Gold Standard. Of the 67 radiographic features, only 25 had sufficient response to allow statistical analysis. Kappa values for intra- and inter-observer variation were estimated. These varied depending on the particular radiographic feature being assessed. Fifteen out of 25 intra-observer recordings showed 'good' or 'very good' Kappa agreement, but only three out of 25 inter-observer observations achieved 'good' or 'very good' values. Inter-observer variation was improved following the revision session with 16 out of 25 observations achieving 'good' or 'very good' Kappa agreement. Modification to the proforma, the criteria used, and training for radiographic assessment were considered necessary to
Hazra, Nisha C; Dregan, Alex; Jackson, Stephen; Gulliford, Martin C
To use primary care electronic health records (EHRs) to evaluate the health of men and women at age 100. Population-based cohort study. Primary care database in the United Kingdom, 1990-2013. Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084, n = 8,982 women, n = 2,102 men). Main categories of morbidity and an index of multiple morbidities, geriatric syndromes and an index of multiple impairments, cardiovascular risk factors. The number of new female centenarians per year increased from 16 per 100,000 in 1990-94 to 25 per 100,000 in 2010-13 (P < .001) and of male centenarians from four per 100,000 to six per 100,000 (P = .06). The most prevalent morbidities at the age of 100 were musculoskeletal diseases, disorders of the senses, and digestive diseases. Women had greater multiple morbidity than men (odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.42-1.89, P < .001). Geriatric syndromes, including falls, fractures, hearing and vision impairment, and dementia, were frequent; 30% of women and 49% of men had no recorded geriatric syndromes. Women had greater likelihood of having multiple geriatric syndromes (OR = 2.14, 95% CI = 1.90-2.41, P < .001). Fewer men than women reach the age of 100, but male centenarians have lower morbidity and fewer geriatric syndromes than women. Research using EHRs offers opportunities to understand the epidemiology of aging and improve care of the oldest old. © 2015 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.
Thakur, Mridul; Jain, Veena; Parkash, Hari; Kumar, Pravesh
To evaluate and compare the centric relation and horizontal condylar guidance using interocclusal wax and extra oral Gothic arch methods and subjective evaluation of dentures thus fabricated. Centric relation and horizontal condylar guidance was recorded by using interocclusal wax and gothic arch tracing in 28 completely edentulous patients. These records were transferred to the articulator and difference in both values was recorded. After that patients were divided in two groups according to the centric relation and horizontal condylar guidance recording method used to achieve balanced occlusion. Response of the dentures was subjectively evaluated using "Woelfel subjective evaluation criteria". Centric relation recorded by both the methods did coincide in 7.14 % of patients. Centric relation recorded by interocclusal wax was posterior to Gothic centric relation in 21.43 % of patients, and anterior to Gothic centric relation in 71.42 % patients. Gothic arch tracings gave higher mean guidance values on both the sides as compared to protrusive wax record in all the subjects, although the difference was statistically insignificant (P > 0.05). Subjective evaluation showed statistical insignificance for all the parameters in both groups. Gothic arch method records the centric relation at a more posterior position than the Static method, but it does not make any difference in clinical performance of the complete denture. Horizontal condylar guidance angle was approximately similar by both the methods.
This guide describes record series that pertain to epidemiologic and health-related studies at the Center for Epidemiologic Research (CER) of the Oak Ridge Institute for Science and Education (ORISE). These records document the health and safety monitoring of employees and contract employees of the Department of Energy (DOE) and its predecessor organizations, the Manhattan Engineer District (MED), the Atomic Energy Commission (AEC), and the Energy Research and Development Administration (ERDA). History Associates Incorporated (HAI) prepared this guide as part of DOE's Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI's role in the project, the history of the DOE and its epidemiologic research program, and the history of the Oak Ridge Reservation and the Oak Ridge Institute for Science and Education. It also furnishes information on the procedures that HAI sued to select, inventory, and describe pertinent records; the methodology used to produce the guide; the arrangement of the record series descriptions; the location of the records; and procedures for accessing records repositories
This guide describes record series that pertain to epidemiologic and health-related studies at the Center for Epidemiologic Research (CER) of the Oak Ridge Institute for Science and Education (ORISE). These records document the health and safety monitoring of employees and contract employees of the Department of Energy (DOE) and its predecessor organizations, the Manhattan Engineer District (MED), the Atomic Energy Commission (AEC), and the Energy Research and Development Administration (ERDA). History Associates Incorporated (HAI) prepared this guide as part of DOE`s Epidemiologic Records Inventory Project. This introduction briefly describes the Epidemiologic Records Inventory Project, HAI`s role in the project, the history of the DOE and its epidemiologic research program, and the history of the Oak Ridge Reservation and the Oak Ridge Institute for Science and Education. It also furnishes information on the procedures that HAI sued to select, inventory, and describe pertinent records; the methodology used to produce the guide; the arrangement of the record series descriptions; the location of the records; and procedures for accessing records repositories.
Quinlivan, Julie A; Lyons, Sarah; Petersen, Rodney W
On July 1, 2012 the Australian Government launched the personally controlled electronic health record (PCEHR). This article surveys obstetric patients about their medical record preferences and identifies barriers to adoption of the PCEHR. A survey study was conducted of antenatal patients attending a large Australian metropolitan hospital. Consecutive patients completed questionnaires during the launch phase of the PCEHR system. Quantitative and qualitative data were collected on demographics, computer access and familiarity, preference for medical record system, and perceived benefits and concerns. Of 528 women eligible to participate, 474 completed the survey (89.8%). Respondents had high levels of home access to a computer (90.5%) and the Internet (87.1%) and were familiar with using computers in daily life (median Likert scale of 9 out of 10). Despite this, respondents preferred hospital-held paper records, and only one-third preferred a PCEHR; the remainder preferred patient-held records. Compared with hospital-held paper records, respondents felt a PCEHR would reduce the risk of lost records (padvantages and disadvantages with the PCEHR, although the majority still prefer existing record systems. To increase uptake, confidentiality, privacy, and control concerns need to be addressed.
Ford, Elizabeth; Campion, Alice; Chamles, Darleen Aixora; Habash-Bailey, Haniah; Cooper, Maxwell
Objectives Anxiety is a common condition usually managed in general practice (GP) in the UK. GP patient records can be used for epidemiological studies of anxiety as well as clinical audit and service planning. However, it is not clear how general practitioners (GPs) conceptualise, diagnose and document anxiety in these records. We sought to understand these factors through an interview study with GPs. Setting UK National Health Service (NHS) General Practice (England and Wales). Participants 17 UK GPs. Primary and secondary outcome measures Semistructured interviews used vignettes to explore the process of diagnosing anxiety in primary care and investigate influences on recording. Interviews were transcribed verbatim and analysed using thematic analysis. Results GPs chose 12 different codes for recording anxiety in the 2 vignettes, and reported that history, symptoms and management would be recorded in free text. GPs reported on 4 themes representing influences on recording of anxiety: ‘anxiety or a normal response’, ‘granularity of diagnosis’, ‘giving patients a label’ and ‘time as a tool’; and 3 themes about recording in general: ‘justifying the choice of code’, ‘usefulness of coding’ and ‘practice-specific pressures’. GPs reported using only a regular selection of codes in patient records to help standardise records within the practice and as a time-saving measure. Conclusions We have identified a coding culture where GPs feel confident recognising anxiety symptoms; however, due to clinical uncertainty, a long-term perspective and a focus on management, they are reluctant to code firm diagnoses in the initial stages. Researchers using GP patient records should be aware that GPs may prefer free text, symptom codes and other general codes rather than firm diagnostic codes for anxiety. PMID:27338879
Robe, Dominic M.; Boettcher, Stefan; Sibani, Paolo
When quenched rapidly beyond their glass transition, colloidal suspensions fall out of equilibrium. The pace of their dynamics then slows down with the system age, i.e., with the time elapsed after the quench. This breaking of time translational invariance is associated with dynamical observables......-facto irreversible and become increasingly harder to achieve. Thus, a progression of record-sized dynamical barriers are traversed in the approach to equilibration. Accordingly, the statistics of the events is closely described by a log-Poisson process. Originally developed for relaxation in spin glasses...
Yu, Tzy-Chyi; Zhou, Huanxue
Electronic health records (EHRs) can provide valuable data for outcomes research. However, unlike administrative claims databases, EHRs lack eligibility tables or a standard way to define the benefit coverage period, which could lead to underreporting of healthcare utilization or outcomes, and could result in surveillance bias. We tested the effect of using a proxy eligibility period (eligibility proxy) when estimating a range of health resource utilization and outcomes parameters under varying degrees of missing encounter data. We applied an eligibility proxy to create a benchmark cohort of chronic obstructive pulmonary disease (COPD) patients with 12 months of follow-up, with the assumption of no missing encounter data. The benchmark cohort provided parameter estimates for comparison with 9,000 simulated datasets representing 10-90% of COPD patients (by 10th percentiles) with between 1 and 11 months of continuous missing data. Two analyses, one for datasets using an eligibility proxy and one for those without an eligibility proxy, were performed on the 9,000 datasets to assess estimator performance under increasing levels of missing data. Estimates for each study variable were compared with those from the benchmark dataset, and performance was evaluated using bias, percentage change, and root-mean-square error. The benchmark dataset contained 6,717 COPD patients, whereas the simulated datasets where the eligibility proxy was applied had between 671 and 6,045 patients depending on the percentage of missing data. Parameter estimates had better performance when an eligibility proxy based on the first and last month of observed activity was applied. This finding was consistent across a range of variables representing patient comorbidities, symptoms, outcomes, health resource utilization, and medications, regardless of the measures of performance used. Without the eligibility proxy, all evaluated parameters were consistently underestimated. In a large COPD patient
Background Prevalence studies usually depend on self-report of disease status in survey data or administrative data collections and may over- or under-estimate disease prevalence. The establishment of a linked data collection provided an opportunity to explore the accuracy and completeness of capture of information about diabetes in survey and administrative data collections. Methods Baseline questionnaire data at recruitment to the 45 and Up Study was obtained for 266,848 adults aged 45 years and over sampled from New South Wales, Australia in 2006–2009, and linked to administrative data about hospitalisation from the Admitted Patient Data Collection (APDC) for 2000–2009, claims for medical services (MBS) and pharmaceuticals (PBS) from Medicare Australia data for 2004–2009. Diabetes status was determined from response to a question ‘Has a doctor EVER told you that you have diabetes’ (n = 23,981) and augmented by examination of free text fields about diagnosis (n = 119) or use of insulin (n = 58). These data were used to identify the sub-group with type 1 diabetes. We explored the agreement between self-report of diabetes, identification of diabetes diagnostic codes in APDC data, claims for glycosylated haemoglobin (HbA1c) in MBS data, and claims for dispensed medication (oral hyperglycaemic agents and insulin) in PBS data. Results Most participants with diabetes were identified in APDC data if admitted to hospital (79.3%), in MBS data with at least one claim for HbA1c testing (84.7%; 73.4% if 2 tests claimed) or in PBS data through claim for diabetes medication (71.4%). Using these alternate data collections as an imperfect ‘gold standard’ we calculated sensitivities of 83.7% for APDC, 63.9% (80.5% for two tests) for MBS, and 96.6% for PBS data and specificities of 97.7%, 98.4% and 97.1% respectively. The lower sensitivity for HbA1c may reflect the use of this test to screen for diabetes suggesting that it is less useful in identifying
Jeremy Herr; Homer A. Neal; Mitch McLachlan
The University of Michigan Web Archives for the 2006 ATLAS Week Plenary Sessions, as well as the first of 2007, are now online. In addition, there are a wide variety of Software and Physics Tutorial sessions, recorded over the past couple years, to chose from. All ATLAS-specific archives are accessible here.Viewing requires a standard web browser with RealPlayer plug-in (included in most browsers automatically) and works on any major platform. Lectures can be viewed directly over the web or downloaded locally.In addition, you will find access to a variety of general tutorials and events via the portal. Shaping Collaboration 2006The Michigan group is happy to announce a complete set of recordings from the Shaping Collaboration conference held last December at the CICG in Geneva.The event hosted a mix of Collaborative Tool experts and LHC Users, and featured presentations by the CERN Deputy Director General, Prof. Jos Engelen, the President of Internet2, and chief developers from VRVS/EVO, WLAP, and other tools...
http://cern.ch/Record.Club Nouveautés été 2011 Le club de location de CDs et de DVDs vient d’ajouter un grand nombre de disques pour l’été 2011. Parmi eux, Le Discours d’un Roi, oscar 2011 du meilleur film et Harry Potter les reliques de la mort (1re partie). Ce n’est pas moins de 48 DVDs et 10 CDs nouveaux qui vous sont proposés à la location. Il y en a pour tous les genres. Alors n’hésitez pas à consulter notre site http://cern.ch/record.club, voir Disc Catalogue, Discs of the month pour avoir la liste complète. Le club est ouvert tous les Lundi, Mercredi, Vendredi de 12h30 à 13h dans le bâtiment du restaurent N°2 (Cf. URL: http://www.cern.ch/map/building?bno=504) A très bientôt.
http://cern.ch/Record.Club June Selections We have put a significant number of new CDs and DVDs into the Club You will find the full lists at http://cern.ch/record.club and select the «Discs of the Month» button on the left side on the left panel of the web page and then June 2011. New films include the latest Action, Suspense and Science Fiction film hits, general drama movies including the Oscar-winning The King’s Speech, comedies including both chapter of Bridget Jones’s Diary, seven films for children and a musical. Other highlights include the latest Harry Potter release and some movies from the past you may have missed including the first in the Terminator series. New CDs include the latest releases by Michel Sardou, Mylene Farmer, Jennifer Lopez, Zucchero and Britney Spears. There is also a hits collection from NRJ. Don’t forget that the Club is now open every Monday, Wednesday and Friday lunchtimes from 12h30 to 13h00 in Restaurant 2, Building 504. (C...
Bonjour a tous, Voici les 24 nouveaux DVD de Juillet disponibles depuis quelques jours, sans oublier les 5 CD Pop musique. Découvrez la saga du terroriste Carlos, la vie de Gainsbourg et les aventures de Lucky Luke; angoissez avec Paranormal Activity et évadez vous sur Pandora dans la peau d’Avatar. Toutes les nouveautés sont à découvrir directement au club. Pour en connaître la liste complète ainsi que le reste de la collection du Record Club, nous vous invitons sur notre site web: http://cern.ch/crc. Toutes les dernières nouveautés sont dans la rubrique « Discs of the Month ». Rappel : le club est ouvert les Lundis, Mercredis, Vendredis de 12h30 à 13h00 au restaurant n°2, bâtiment 504. A bientôt chers Record Clubbers.
http://cern.ch/Record.Club November Selections Just in time for the holiday season, we have added a number of new CDs and DVDs into the Club. You will find the full lists at http://cern.ch/record.club; select the "Discs of the Month" button on the left side on the left panel of the web page and then Nov 2011. New films include the all 5 episodes of Fast and Furious, many of the most famous films starring Jean-Paul Belmondo and those of Louis de Funes and some more recent films such as The Lincoln Lawyer and, according to some critics, Woody Allen’s best film for years – Midnight in Paris. For the younger generation there is Cars 2 and Kung Fu Panda 2. New CDs include the latest releases by Adele, Coldplay and the Red Hot Chili Peppers. We have also added the new Duets II CD featuring Tony Bennett singing with some of today’s pop stars including Lady Gaga, Amy Winehouse and Willy Nelson. The Club is now open every Monday, Wednesday and Friday ...
He, Siran; Lunnen, Jeffrey C; Zia, Nukhba; Khan, Uzma; Shamim, Khusro; Hyder, Adnan A
Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap. Patients who presented with a complaint of "near-drowning" were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the "near-drowning" complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization. A total of 133 patients (0.2% of all injury patients) with "near-drowning" as presenting complaints were recorded by the Pak-NEDS system. True near-drowning (50.0%) and intentional injuries that led to "near-drowning" complaints (50.0%) differed in nature of injuries. The highest proportion of true near-drowning incidents occurred among patients aged between 25-44 years (47.5%), and among males (77.5%). True near-drowning patients usually had other accompanying complaints, such as lower limb injury (40.0%). Very few patients were transported by ambulance (5.0%), and triage was done for 15% of patients. Eleven (27.5%) true near-drowning patients received cardiopulmonary resuscitation. There was major under-reporting of drowning and near-drowning cases in the surveillance study. The etiology of near-drowning cases should be further studied. Patients who experienced non-fatal drownings were more commonly sent for medical care due to other accompanying conditions, rather than near-drowning event itself. There is also need for recognizing true near-drowning incidents. The results of this study provide information on data source selection, site location, emergency care standardization, and multi-sector collaboration for future drowning
Full Text Available The personal health record (PHR is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT and Unified Theory of Acceptance and Use of Technology (UTAUT model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1 The PMT and UTAUT were effective at predicting PHR usage behaviors; (2 Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3 Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management.
Chaix, Basile; Bean, Kathy; Leal, Cinira; Thomas, Frédérique; Havard, Sabrina; Evans, David; Jégo, Bertrand; Pannier, Bruno
Recent studies have started to suggest that, beyond effects of individual socioeconomic profiles, socioeconomic characteristics of residential neighborhoods are independently associated with blood pressure. However, mechanisms involved in these associations remain unknown. To distinguish between different mechanisms, we investigated whether specific risk factors of hypertension (physical inactivity, alcohol consumption, smoking, body mass index, waist circumference, and resting heart rate) intervene as mediators in the associations between individual or neighborhood socioeconomic characteristics and systolic blood pressure. We relied on data from the RECORD Cohort Study (Residential Environment and CORonary heart Disease) on 5941 participants recruited in 2007-2008, aged 30 to 79 years, residing in 1824 neighborhoods in the Paris metropolitan area. Systolic blood pressure increased independently and regularly with both decreasing individual education and decreasing residential neighborhood education. Body mass index/waist circumference and resting heart rate mediated an appreciable share of the associations between education and blood pressure and, adding validity to the finding, were the 2 most significant mediators for the effects of both individual education and neighborhood education. We found that 52% (95% CI: 25% to 79%) of the association between neighborhood education and blood pressure was mediated by body mass index/waist circumference and 20% (95% CI: 5% to 36%) by resting heart rate. Future research will have to clarify the exact mechanisms through which body weight and shape and resting heart rate intervene as mediators in the associations between individual/neighborhood education and blood pressure.
Ekeland, Anne G; Skipenes, Eva; Nyheim, Beate; Christiansen, Ellen K
The University Hospital of North Norway selected a web-based ulcer record used in Denmark, available from mobile phones. Data was stored in a common database and easily accessible. According to Norwegian legislation, only employees of the organization that owns an IT system can access the system, and use of mobile units requires strong security solutions. The system had to be changed. The paper addresses interactions in order to make the system legal, and assesses regulations that followed. By addressing conflicting scripts and the contingent nature of knowledge, we conducted a formative evaluation aiming at improving the object being studied. Participatory observation in a one year process, minutes from meetings and information from participants, constitute the data material. In the technological domain, one database was replaced by four. In the health care delivery domain, easy access was replaced by a more complicated log on procedure, and in the domain of law and security, a clarification of risk levels was obtained, thereby allowing for access by mobile phones with today's authentication mechanisms. Flexibility concerning predefined scripts was important in all domains. Changes were made that improved the platform for further development of legitimate communication of patient data via mobile units. The study also shows the value of formative evaluations in innovations.
Tyrstrup, Mia; Beckman, Anders; Mölstad, Sigvard; Engström, Sven; Lannering, Christina; Melander, Eva; Hedin, Katarina
Swedish studies on antibiotic use in primary care have been based on one-week registrations of infections. In order to study adherence to guidelines, analyses based on large databases that provide information on diagnosis linked prescriptions, are needed. This study describes trends in management of infections in Swedish primary care particularly with regards to antibiotic prescribing and adherence to national guidelines. A descriptive study of Sweden's largest database regarding diagnosis linked antibiotic prescription data, the Primary care Record of Infections in Sweden (PRIS), for the years 2008, 2010 and 2013. Although the consultation rate for all infections remained around 30% each year, antibiotic prescribing rates decreased significantly over the years from 53.7% in 2008, to 45.5% in 2010, to 38.6% in 2013 (p = .032). The antibiotic prescribing rate for respiratory tract infections (RTIs) decreased from 40.5% in 2008 to 24.9% in 2013 while those for urinary tract infections and skin and soft tissue infections were unchanged. For most RTI diagnoses there was a decrease in prescription rate from 2008 to 2013, particularly for the age group 0-6 years. Phenoxymethylpenicillin (PcV) was the antibiotic most often prescribed, followed by tetracycline. Tonsillitis and acute otitis media were the two RTI diagnoses with the highest number of prescriptions per 1000 patient years (PY). For these diagnoses an increase in adherence to national guidelines was seen, with regards to treatment frequency, choice of antibiotics and use of rapid antigen detection test. The frequency in antibiotic prescribing varied greatly between different Primary Healthcare Centres (PHCCs). Falling numbers of consultations and decreased antibiotic prescription rates for RTIs have reduced the antibiotic use in Swedish primary care substantially. Overprescribing of antibiotics could still be suspected due to large variability in prescribing frequency, especially for acute bronchitis and
DVD James Bond – Series Complete To all Record Club Members, to start the new year, we have taken advantage of a special offer to add copies of all the James Bond movies to date, from the very first - Dr. No - to the latest - Quantum of Solace. No matter which of the successive 007s you prefer (Sean Connery, George Lazenby, Roger Moore, Timothy Dalton, Pierce Brosnan or Daniel Craig), they are all there. Or perhaps you have a favourite Bond Girl, or even perhaps a favourite villain. Take your pick. You can find the full selection listed on the club web site http://cern.ch/crc; use the panel on the left of the page “Discs of the Month” and select Jan 2010. We remind you that we are open on Mondays, Wednesdays and Fridays from 12:30 to 13:00 in Restaurant 2 (Bldg 504).
Antonella Del Rosso
In the sixties, CERN’s Fellows were but a handful of about 50 young experimentalists present on site to complete their training. Today, their number has increased to a record-breaking 500. They come from many different fields and are spread across CERN’s different activity areas. “Diversifying the Fellowship programme has been the key theme in recent years,” comments James Purvis, Head of the Recruitment, Programmes and Monitoring group in the HR Department. “In particular, the 2005 five-yearly review introduced the notion of ‘senior’ and ‘junior’ Fellowships, broadening the target audience to include those with Bachelor-level qualifications.” Diversification made CERN’s Fellowship programme attractive to a wider audience but the number of Fellows on site could not have increased so much without the support of EU-funded projects, which were instrumental in the growth of the programme. ...
Full Text Available BINABITROP is a bibliographical database of more than 38 000 records about the ecosystems and organisms of Costa Rica. In contrast with commercial databases, such as Web of Knowledge and Scopus, which exclude most of the scientific journals published in tropical countries, BINABITROP is a comprehensive record of knowledge on the tropical ecosystems and organisms of Costa Rica. We analyzed its contents in three sites (La Selva, Palo Verde and Las Cruces and recorded scientific field, taxonomic group and authorship. We found that most records dealt with ecology and systematics, and that most authors published only one article in the study period (1963-2011. Most research was published in four journals: Biotropica, Revista de Biología Tropical/ International Journal of Tropical Biology and Conservation, Zootaxa and Brenesia. This may be the first study of a such a comprehensive database for any case of tropical biology literature.
Monge-Nájera, Julián; Nielsen-Muñoz, Vanessa; Azofeifa-Mora, Ana Beatriz
BINABITROP is a bibliographical database of more than 38000 records about the ecosystems and organisms of Costa Rica. In contrast with commercial databases, such as Web of Knowledge and Scopus, which exclude most of the scientific journals published in tropical countries, BINABITROP is a comprehensive record of knowledge on the tropical ecosystems and organisms of Costa Rica. We analyzed its contents in three sites (La Selva, Palo Verde and Las Cruces) and recorded scientific field, taxonomic group and authorship. We found that most records dealt with ecology and systematics, and that most authors published only one article in the study period (1963-2011). Most research was published in four journals: Biotropica, Revista de Biología Tropical/ International Journal of Tropical Biology and Conservation, Zootaxa and Brenesia. This may be the first study of a such a comprehensive database for any case of tropical biology literature.
... do students' language skills, background knowledge, and comprehension develop in Title I schools... with children's development of language skills, background knowledge, and comprehension in... hard copy. RETRIEVABILITY: Records in this system are indexed and retrieved by a number assigned to...
McCarty Catherine A
Full Text Available Abstract Introduction The eMERGE (electronic MEdical Records and GEnomics Network is an NHGRI-supported consortium of five institutions to explore the utility of DNA repositories coupled to Electronic Medical Record (EMR systems for advancing discovery in genome science. eMERGE also includes a special emphasis on the ethical, legal and social issues related to these endeavors. Organization The five sites are supported by an Administrative Coordinating Center. Setting of network goals is initiated by working groups: (1 Genomics, (2 Informatics, and (3 Consent & Community Consultation, which also includes active participation by investigators outside the eMERGE funded sites, and (4 Return of Results Oversight Committee. The Steering Committee, comprised of site PIs and representatives and NHGRI staff, meet three times per year, once per year with the External Scientific Panel. Current progress The primary site-specific phenotypes for which samples have undergone genome-wide association study (GWAS genotyping are cataract and HDL, dementia, electrocardiographic QRS duration, peripheral arterial disease, and type 2 diabetes. A GWAS is also being undertaken for resistant hypertension in ≈2,000 additional samples identified across the network sites, to be added to data available for samples already genotyped. Funded by ARRA supplements, secondary phenotypes have been added at all sites to leverage the genotyping data, and hypothyroidism is being analyzed as a cross-network phenotype. Results are being posted in dbGaP. Other key eMERGE activities include evaluation of the issues associated with cross-site deployment of common algorithms to identify cases and controls in EMRs, data privacy of genomic and clinically-derived data, developing approaches for large-scale meta-analysis of GWAS data across five sites, and a community consultation and consent initiative at each site. Future activities Plans are underway to expand the network in diversity of
Full Text Available Background: Contrary to popular perception, several dermatological conditions may be associated with lethal outcome in the absence of timely intervention or due to complications. Aims: The aim was to estimate the number of deaths and analyze their causes due to skin disorders at a tertiary level inpatient dermatology ward. Materials and Methods: We conducted a retrospective, record-based observational study involving 538 patients spanning over 4 years (2013–2016 at our dermatology indoor setup. Results: There were 45 deaths (male:female = 1.5:1, accounting for 8.4% or total admissions, occurring mostly in patients in their 7th decade. Vesiculobullous disorders were the most frequent cause of mortality (57.8%, followed by drug reactions accounting for 17.8% of cases. In the former group pemphigus vulgaris accounted for most deaths (31.1% followed by bullous pemphigoid (17.8% and pemphigus foliaceus (8.9%, whereas toxic epidermal necrolysis was the most frequent cause of death from drug reactions (8.9%. Almost half of all deaths (48.9% occurred due to septicemia followed by cardiopulmonary complications (40%. Most of the cases presented to us at an advanced state of the disease previously being treated inappropriately. Conclusion: Prompt diagnosis and treatment of such dermatological conditions are mandated, preferably in an intensive care set-up, to reduce mortality rates. Advanced age, the area of skin involvement, mucosal involvement, and septicemia were adverse prognostic factors in these patients.
Jason A. Robins
Full Text Available Background: Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates’ documentation, the heterogeneity therein, as well as its objective data. Methods: Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Results: Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Conclusions: Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.
Robins, Jason A; McInnes, Matthew D F; Esmail, Kaisra
Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates' documentation, the heterogeneity therein, as well as its objective data. Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.
Luque, Amneris E; Corales, Roberto; Fowler, Richard J; DiMarco, Jamie; van Keken, Adjuah; Winters, Paul; Keefer, Michael C; Fiscella, Kevin
Persons living with HIV (PLWH) need practical tools to self-manage their condition. We conducted a proof-of-concept study among PLWH to assess whether patients could learn to use a personal health record (PHR) on a hand-held device (iPod Touch) to manage their condition. We began individual trainings and later adapted this to group training. We assessed usability, acceptability and also effects on self-efficacy for treatment adherence using the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). Nine PLWH participated in the individual training and 29 participated in the group sessions. The participants were largely middle aged, low-income and of racial/ethnic minorities. The sessions were well attended and participants fully engaged in tasks and shared learning. Most participants stated they intended to use the PHR and reported improved self-efficacy in treatment adherence (P = .05) particularly on the integration of treatment adherence into one's routine (P < .02). Training PLWH in use of a handheld PHR shows promise.
Ramakrishna, S. S. V. S.
The Indian summer monsoon season of 2014 was erratic and ended up with a seasonal rainfall deficit of 12 % and a record drought in June. In this study we analyze the moisture transport characteristics for the monsoon season of 2014 using both NCEP FNL reanalysis (FNL) and CFSv2 (CFS) model data. In FNL, in June 2014 there was a large area of divergence of moisture flux. In other months also there was lesser flux. This probably is the cause of 2014 drought. The CFS model overestimated the drought and it reproduces poorly the observed rainfall over central India (65E–95E; 5N–35N). The correlation coefficient (CC) between the IMD observed rainfall and CFS model rainfall is only 0.1 while the CC between rainfall and moisture flux convergence in CFS model is only 0.20 and with FNL data −0.78. This clearly shows that the CFS model has serious difficulty in reproducing the moisture flux convergence and rainfall. We found that the rainfall variations are strongly related to the moisture convergence or divergence. The hypothesis of Krishnamurti et al. (J Atmos Sci 67:3423–3441, 2010) namely the intrusion of west African desert air and the associated low convective available potential energy inhibiting convection and rainfall shows some promise to explain dry spells in Indian summer monsoon. However, the rainfall or lack of it is mainly explained by convergence or divergence of moisture flux. © 2016 Springer-Verlag Berlin Heidelberg
Borel, Jean-Christian; Pelletier, Julie; Taleux, Nellie; Briault, Amandine; Arnol, Nathalie; Pison, Christophe; Tamisier, Renaud; Timsit, Jean-François; Pepin, Jean-Louis
To assess whether daily variations in three parameters recorded by non-invasive ventilation (NIV) software (respiratory rate (RR), percentage of respiratory cycles triggered by the patient (%Trigg) and NIV daily use) predict the risk of exacerbation in patients with chronic obstructive pulmonary disease (COPD) treated by home NIV. Patients completed the EXACT-Pro questionnaire daily to detect exacerbations. The 25th and 75th percentiles of each 24 h NIV parameter were calculated and updated daily. For a given day, when the value of any parameter was >75th or 75th, 'low value' <25th). Stratified conditional logistic regressions estimated the risk of exacerbation when ≥2 days (for RR and %Trigg) or ≥3 days (for NIV use) out of five had an 'abnormal value'. Sixty-four patients were included. Twenty-one exacerbations were detected and medically confirmed. The risk of exacerbation was increased when RR (OR 5.6, 95% CI 1.4 to 22.4) and %Trigg (OR 4.0, 95% CI 1.1 to 14.5) were considered as 'high value' on ≥2 days out of five. This proof-of-concept study shows that daily variations in RR and %Trigg are predictors of an exacerbation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Jan Michael Kühn
Full Text Available Translator's Introduction: Jan-Michael Kühn's essay introduces the reader to Hubert Knoblauch's focused ethnography [fokussierte Ethnographie] as an ethnographic fieldwork method. More than a decade after Knoblauch's first publications on this method, there are precious few guides to focused ethnography in the English language, save one (Knoblauch 2005. At any rate, there are certainly no introductions to this methodology that also use EDM scenes as a case study. Kühn's article was originally published in German in Soziologie Magazin, a student-run journal published from Martin Luther University in Halle (Saale but operated by an editorial network that spans Germany. As a result, Kühn orients his writing towards an audience of junior researchers, post-docs and graduate students, highlighting the ways in which focused ethnography suits the circumstances of early research careers, where one may have difficulty securing long-term research stays for fieldwork of broader scope. In particular, he notes that Knoblauch's methods require a very narrow scope for the project (i.e., a "field sector" rather than the whole field, a reliance on the researcher's previous knowledge of the field, and short bursts of intense ethnographic activity in order to create work that is tightly focused but still rigorous and generative of fresh knowledge and new concepts.KEYWORDS: qualitative methods; cultural production; music production; home-recording; technoculture
Tavakoli, Nahid; Jahanbakhsh, Maryam; Shahin, Arash; Mokhtari, Habibollah; Rafiei, Maryam
Introduction Today, health information technologies are base of health services and Electronic Medical Record is one of them. The purpose of this paper is to investigate the Technology Acceptance Model (TAM) on EMR at Central Polyclinic Oil Industry that is a pioneer in implementation of EMR in Isfahan. Methods This study was an applied and analytical survey that it was done at the Central Polyclinic Oil Industry. Because statistical population were limited, sampling bas been done by conducting the census and the sample was according to the population. The data was collected by a researcher-made questionnaire that it was validated by experts and its reliability was confirmed by test retest. The questionnaire was developed in 5 scopes including external factors (data quality and user interface), perceived usefulness, perceived ease of usefulness, attitude toward using, and behavioral intention to use. The Results analyzed by SPSS. Results There was a significant relationship between data quality with PU(r=/295, p/005). Discussion The survey of the scopes in the polyclinic showed that there is relationship among user interface, perceived usefulness, perceived ease of usefulness, attitude toward using, and behavioral intention to use, but data quality has no relationship with attitude. It seems the system designers didn’t consider to data quality characteristics. It is proposed that they consult with health information management professionals for improvement the existing system. PMID:23572857
Martin, Shannon K; Tulla, Kiara; Meltzer, David O; Arora, Vineet M; Farnan, Jeanne M
Advances in information technology have increased remote access to the electronic health record (EHR). Concurrently, standards defining appropriate resident supervision have evolved. How often and under what circumstances inpatient attending physicians remotely access the EHR for resident supervision is unknown. We described a model of attending remote EHR use for resident supervision, and quantified the frequency and magnitude of use. Using a mixed methods approach, general medicine inpatient attendings were surveyed and interviewed about their remote EHR use. Frequency of use and supervisory actions were quantitatively examined via survey. Transcripts from semistructured interviews were analyzed using grounded theory to identify codes and themes. A total of 83% (59 of 71) of attendings participated. Fifty-seven (97%) reported using the EHR remotely, with 54 (92%) reporting they discovered new clinical information not relayed by residents via remote EHR use. A majority (93%, 55 of 59) reported that this resulted in management changes, and 54% (32 of 59) reported making immediate changes by contacting cross-covering teams. Six major factors around remote EHR use emerged: resident, clinical, educational, personal, technical, and administrative. Attendings described resident and clinical factors as facilitating "backstage" supervision via remote EHR use. In our study to assess attending remote EHR use for resident supervision, attendings reported frequent remote use with resulting supervisory actions, describing a previously uncharacterized form of "backstage" oversight supervision. Future work should explore best practices in remote EHR use to provide effective supervision and ultimately improve patient safety.
Korur, Asli; Asma, Süheyl; Gereklioglu, Cigdem; Solmaz, Soner; Boga, Can; Ozsahin, Akatlı Kürsat; Kut, Altug
In this study, we investigated the influence of electronic health records (EHR) and electronic vaccination schedule applications on the vaccination status of patients who were admitted to our Center for the treatment of sickle cell disease (SCD). The vaccination status against influenza and pneumococcus infection was determined in 93 patients who were admitted to the hematology outpatient clinic, Baskent University Adana Hospital from April 2004 to March 2009. The vaccination status was then re-evaluated following establishment of EHR and electronic vaccination schedules in 2012. Of the 93 patients with SCD 21.5% (n = 20) were vaccinated against pneumococcus and 21.5% (n = 20) were regularly vaccinated against influenza. When the vaccination rates of 59 of 93 patients who presented for their regular control examinations were analyzed following establishment of EHR and vaccination schedules in 2012, these rates were 49.2% (n = 29) and 50.8% (n = 30) for influenza and pneumococcus, respectively, after EHR; there were 23.7% (n = 14) and 20.3% (n = 12), respectively, before EHR. A statistically significant difference was found between the vaccination rates before and after EHR (p < 0.05). Although viral and bacterial infections are life-threatening health problems in patients with SCD, the vaccination rates were low in high-risk patients. However, these rates increased after application of electronic vaccination schedules.
Forster, Alice S; Burgess, Caroline; Dodhia, Hiten; Fuller, Frances; Miller, Jane; McDermott, Lisa; Gulliford, Martin C
To evaluate the effect of NHS Health Checks on cardiovascular risk factor detection and inequalities. Matched cohort study in the Clinical Practice Research Datalink, including participants who received a health check in England between 1 April 2010 and 31 March 2013, together with matched control participants, with linked deprivation scores. There were 91 618 eligible participants who received a health check, of whom 75 123 (82%) were matched with 182 245 controls. After the health check, 90% of men and 92% of women had complete data for blood pressure, total cholesterol, smoking and body mass index; a net 51% increase (P < 0.001) over controls. After the check, gender and deprivation inequalities in recording of all risk factors were lower than for controls. Net increase in risk factor detection was greater for hypercholesterolaemia (men +33%; women +32%) than for obesity (men +8%; women +4%) and hypertension in men only (+5%) (all P < 0.001). Detection of smoking was 5% lower in health check participants than controls (P < 0.001). Over 4 years, statins were prescribed to 11% of health -check participants and 7.6% controls (hazard ratio 1.58, 95% confidence interval 1.53-1.63, P < 0.001). NHS Health Checks are associated with increased detection of hypercholesterolaemia, and to a lesser extent obesity and hypertension, but smokers may be under-represented. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health.
Melanie D Logue
Full Text Available Background Despite international efforts moving toward integrated care using health information technologies and the potential of electronic PHRs to help us better coordinate patient-centered care, PHR adoption in the United States remains low among patients who have been offered free access to them from private-sector companies. If older adult stand to benefit from the use of PHRs for its usefulness in self-managing chronic illness, why have they not been more readily adopted? Since the chronically ill older adult has unique circumstances that impact their decision to participate in self-directed care, a theoretical framework to help understand factors that influence the adoption of PHRs is important. Here we describe the results of an exploratory study that provided an initial test of such a framework.Methods The study used a descriptive survey methodology with 38 older adults. The survey questionnaire asked about the personal barriers and facilitators associated with personal health record adoption and included items measuring each of the PHRAM’s four interacting factors (environmental factors, personal factors, technology factors, and self-management, and the resulting behavioural outcome.Results Younger seniors had a more positive attitude toward computers, knew what health resources were available on the internet, agreed that they had the resources in place to use PHRs, and would be more influenced by a family member than a healthcare provider to use them. Conversely, older seniors reported less confidence in their ability to use Internet-based PHRs and did not perceive that they had the resources in place to use them.Conclusions The results of this study indicated that personal, environmental, technology, chronic illness, and behavioral factors operated concurrently as personal barriers and/or facilitators to the adoption of PHRs among the older adult with chronic illness. These factors cannot be isolated because the person commonly
Qutob, Akram F; Allen, Gabrielle; Gue, Sumant; Revesz, Tamas; Logan, Richard M; Keefe, Dorothy
This retrospective/prospective study was carried out to implement a standardized hospital oral care protocol and record the incidence of oral mucositis for inpatients with childhood cancer. The implementation process included stages of collaboration, consultation, education, and evaluation. The retrospective part of the study documented the existing hospital oral care protocol and audited medical records of all pediatric patients diagnosed with cancer over a 12-month period. The frequency of recorded oral mucositis and the rate of referral to the pediatric dentistry department were assessed. Following evaluation of the retrospective study, the literature was searched to create a new hospital oral care protocol. Referral to the dental department was standardized and frequent in-service presentations were given to staff. The oral mucositis scale was recorded daily for all inpatients, and compliance rates were assessed. Fifty-nine patients' medical records were audited during the retrospective study. Oral mucositis prevalence was clearly documented at 34%, while an additional 20% lacked a definitive diagnosis. During the prospective study, 38 patients were followed and had a verified incidence of oral mucositis of 33%. The rate of compliance of implementing the oral mucositis scale improved from 41% during the first 4 months to 87% during last 3 months. Referral rates to the dental department increased from 53% during the retrospective study to 100% during the prospective study. Mutual understanding and collaboration between the oncology and dental departments in hospitals is crucial for standardizing patient care and for improving oral care standards.
National Archives and Records Administration — The Records Control Schedules (RCS) repository provides access to scanned versions of records schedules, or Standard Form 115, Request for Records Disposition...
Full Text Available INTRODUCTION: Assessing the contextual factors that influence walking for transportation is important to develop more walkable environments and promote physical activity. To advance previous research focused on residential environments and overall walking for transportation, the present study investigates objective environmental factors assessed around the residence, the workplace, the home--work itinerary, and the home--supermarket itinerary, and considered overall walking for transportation but also walking to work and to shops. METHODS: Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Multilevel ordinal regression analyses were conducted to investigate environmental characteristics associated with self-reported overall walking for transportation, walking to work, and walking to shops. RESULTS: High individual education was associated with overall walking for transportation, with walking to work, and walking to shops. Among workers, a high residential neighborhood education was associated with increased overall walking for transportation, while a high workplace neighborhood education was related to an increased time spent walking to work. The residential density of destinations was positively associated with overall walking for transportation, with walking to work, and with walking to shops, while the workplace density of destinations was positively associated with overall walking for transportation among workers. Environmental factors assessed around the itineraries were not associated with walking to work or to the shops. CONCLUSION: This research improves our understanding of the role of the environments on walking for transportation by accounting for some of the environments visited beyond the residential neighborhood. It shows that workers' walking habits are more influenced by the density of destinations around the workplace than
Sieswerda, Elske; Font-Gonzalez, Anna; Reitsma, Johannes B.; Dijkgraaf, Marcel G. W.; Heinen, Richard C.; Jaspers, Monique W.; van der Pal, Helena J.; van Leeuwen, Flora E.; Caron, Huib N.
Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9–2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5–10 and 20–30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1–16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6–11.7). Female gender (Phospitalization rates in CCS. In conclusion, CCS have increased hospitalization rates compared to the general population, up to at least 30 years after primary cancer treatment. These findings imply a high and long-term burden of unfavorable health conditions after childhood cancer on survivors and health care resources. PMID:27433937
Rudisill, C; Charlton, J; Booth, H P; Gulliford, M C
The objective of this study was to evaluate the association between body mass index (BMI) and healthcare costs in relation to obesity-related comorbidity and depression. A population-based cohort study was undertaken in the UK Clinical Practice Research Datalink (CPRD). A stratified random sample was taken of participants registered with general practices in England in 2008 and 2013. Person time was classified by BMI category and morbidity status using first diagnosis of diabetes (T2DM), coronary heart disease (CHD), stroke or malignant neoplasms. Participants were classified annually as depressed or not depressed. Costs of healthcare utilization were calculated from primary care records with linked hospital episode statistics. A two-part model estimated predicted mean annual costs by age, gender and morbidity status. Linear regression was used to estimate the effects of BMI category, comorbidity and depression on healthcare costs. The analysis included 873 809 person-years (62% female) from 250 046 participants. Annual healthcare costs increased with BMI, to a mean of £456 (95% CI 344-568) higher for BMI ≥40 kg m(-2) than for normal weight based on a general linear model. After adjusting for BMI, the additional cost of comorbidity was £1366 (£1269-£1463) and depression £1044 (£973-£1115). There was evidence of interaction so that as the BMI category increased, additional costs of comorbidity (£199, £74-£325) or depression (£116, £16-£216) were greater. High healthcare costs in obesity may be driven by the presence of comorbidity and depression. Prioritizing primary prevention of cardiovascular disease and diabetes in the obese population may contribute to reducing obesity-related healthcare costs. © 2016 World Obesity.
March Selections By the time this appears, we will have added a number of new CDs and DVDs into the Club. You will find the full lists at http://cern.ch/record.club; select the "Discs of the Month" button on the left panel of the web page and then Mar 2012. New films include recent releases such as Johnny English 2, Bad Teacher, Cowboys vs Aliens, and Super 8. We are also starting to acquire some of the classic films we missed when we initiated the DVD section of the club, such as appeared in a recent Best 100 Films published by a leading UK magazine; this month we have added Spielberg’s Jaws and Scorsese’s Goodfellas. If you have your own ideas on what we are missing, let us know. For children we have no less than 8 Tin-Tin DVDs. And if you like fast moving pop music, try the Beyonce concert DVD. New CDs include the latest releases from Paul McCartney, Rihanna and Amy Winehouse. There is a best of Mylene Farmer, a compilation from the NRJ 201...
Kaufman, David R; Sheehan, Barbara; Stetson, Peter; Bhatt, Ashish R; Field, Adele I; Patel, Chirag; Maisel, James Mark
The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)-enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user's experience. The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods ("protocols") of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes
Jacobs, Myrthe; Cooper, Sally-Ann; McGowan, Ruth; Nelson, Scott M; Pell, Jill P
Previous studies have demonstrated the influence of changes in the age at which women give birth, and of developments in prenatal screening and diagnosis on the number of pregnancies diagnosed and terminated with chromosomal anomalies. However, we are unaware of any population studies examining pregnancy terminations after diagnosis of chromosomal anomalies that has included all aneuploidies and the influence of maternal factors. The aims of this study were to examine the association between results of prenatal tests and pregnancy termination, and the proportion of foetuses with and without chromosomal anomalies referred for invasive diagnostic tests over time. Diagnostic information of 26,261 prenatal invasive tests from all genetic service laboratories in Scotland from 2000 to 2011 was linked to Scottish Morbidity Records to obtain details on pregnancy outcome. Binary logistic regression was carried out to test the associations of year and type of diagnosis with pregnancy termination, while controlling for maternal age, neighbourhood deprivation and parity. There were 24,155 (92.0%) with no chromosomal anomalies, 1,483 (5.6%) aneuploidy diagnoses, and 623 (2.4%) diagnoses of anomaly that was not aneuploidy (including translocations and single chromosome deletions). In comparison with negative test results, pregnancies diagnosed with trisomy were most likely to be terminated (adjusted OR 437.40, 95% CI 348.19-549.46) followed by other aneuploid anomalies (adjusted OR 95.94, 95% CI 69.21-133.01). During the study period, fewer pregnancies that were diagnosed with aneuploidy were terminated, including trisomy diagnoses (adjusted OR 0.44, 95% CI 0.26-0.73). Older women were less likely to terminate (OR 0.35, 95% CI 0.28, 0.42), and parity was also an independent predictor of termination. In keeping with previous findings, while the number of invasive diagnostic tests declined, the proportion of abnormal results increased from 6.09% to 10.88%. Systematic advances in
Full Text Available Abstract Background Swedish studies on antibiotic use in primary care have been based on one-week registrations of infections. In order to study adherence to guidelines, analyses based on large databases that provide information on diagnosis linked prescriptions, are needed. This study describes trends in management of infections in Swedish primary care particularly with regards to antibiotic prescribing and adherence to national guidelines. Methods A descriptive study of Sweden’s largest database regarding diagnosis linked antibiotic prescription data, the Primary care Record of Infections in Sweden (PRIS, for the years 2008, 2010 and 2013. Results Although the consultation rate for all infections remained around 30% each year, antibiotic prescribing rates decreased significantly over the years from 53.7% in 2008, to 45.5% in 2010, to 38.6% in 2013 (p = .032. The antibiotic prescribing rate for respiratory tract infections (RTIs decreased from 40.5% in 2008 to 24.9% in 2013 while those for urinary tract infections and skin and soft tissue infections were unchanged. For most RTI diagnoses there was a decrease in prescription rate from 2008 to 2013, particularly for the age group 0–6 years. Phenoxymethylpenicillin (PcV was the antibiotic most often prescribed, followed by tetracycline. Tonsillitis and acute otitis media were the two RTI diagnoses with the highest number of prescriptions per 1000 patient years (PY. For these diagnoses an increase in adherence to national guidelines was seen, with regards to treatment frequency, choice of antibiotics and use of rapid antigen detection test. The frequency in antibiotic prescribing varied greatly between different Primary Healthcare Centres (PHCCs. Conclusion Falling numbers of consultations and decreased antibiotic prescription rates for RTIs have reduced the antibiotic use in Swedish primary care substantially. Overprescribing of antibiotics could still be suspected due to large variability
Young, F; Wotton, C J; Critchley, J A; Unwin, N C; Goldacre, M J
The authors aimed to determine whether, and by how much, diabetes mellitus (DM) increases the risk of tuberculosis (TB) and conversely whether TB increases the risk of DM. Retrospective cohort analyses using data from two Oxford Record Linkage Study (ORLS) datasets, containing information on hospital admissions and day-case care between 1963 and 1998 (ORLS1) and between 1999 and 2005 (ORLS2), were carried out. The rate ratio (RR) for tuberculosis after admission to hospital with diabetes and for diabetes after hospital admission with tuberculosis was calculated. In ORLS1, the RR for TB in people admitted to hospital with DM, comparing the latter with a reference cohort, was 1.83 (95% CI 1.26 to 2.60), and in ORLS2 the RR was 3.11 (1.17 to 7.03). RRs for pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) within ORLS1 were similar at, respectively, 1.80 (1.16 to 2.67) and 1.98 (0.88 to 3.92). In ORLS 2 the RR for PTB was 2.63 (0.91 to 6.30). In ORLS1, there was no indication that TB was a risk factor for DM (RR 1.12, 0.76 to 1.60). The ORLS2 dataset was too small to analyse whether TB led to DM. DM was associated with a two- to threefold increased risk of TB within this predominantly white, English population. The authors found no evidence that TB increases the risk of DM. Our findings suggest that the risks of PTB and EPTB were both raised among individuals with DM. As DM prevalence rises, this association will become increasingly important for TB control and treatment.
Gross, Anne H; Leib, Ryan K; Tonachel, Anne; Tonachel, Richard; Bowers, Danielle M; Burnard, Rachel A; Rhinehart, Catherine A; Valentim, Rahila; Bunnell, Craig A
This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient's trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR's communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool's functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.
Greiver, Michelle; Barnsley, Jan; Aliarzadeh, Babak; Krueger, Paul; Moineddin, Rahim; Butt, Debra A; Dolabchian, Edita; Jaakkimainen, Liisa; Keshavjee, Karim; White, David; Kaplan, David
The quality of electronic medical record (EMR) data is known to be problematic; research on improving these data is needed. The primary objective was to explore the impact of using a data entry clerk to improve data quality in primary care EMRs. The secondary objective was to evaluate the feasibility of implementing this intervention. We used a before and after design for this pilot study. The participants were 13 community based family physicians and four allied health professionals in Toronto, Canada. Using queries programmed by a data manager, a data clerk was tasked with re-entering EMR information as coded or structured data for chronic obstructive pulmonary disease (COPD), smoking, specialist designations and interprofessional encounter headers. We measured data quality before and three to six months after the intervention. We evaluated feasibility by measuring acceptability to clinicians and workload for the clerk. After the intervention, coded COPD entries increased by 38% (P = 0.0001, 95% CI 23 to 51%); identifiable data on smoking categories increased by 27% (P = 0.0001, 95% CI 26 to 29%); referrals with specialist designations increased by 20% (P = 0.0001, 95% CI 16 to 22%); and identifiable interprofessional headers increased by 10% (P = 0.45, 95 CI -3 to 23%). Overall, the intervention was rated as being at least moderately useful and moderately usable. The data entry clerk spent 127 hours restructuring data for 11 729 patients. Utilising a data manager for queries and a data clerk to re-enter data led to improvements in EMR data quality. Clinicians found this approach to be acceptable.
Kapa, Suraj; Epstein, Andrew E; Callans, David J; Garcia, Fermin C; Lin, David; Bala, Rupa; Riley, Michael P; Hutchinson, Mathew D; Gerstenfeld, Edward P; Tzou, Wendy; Marchlinski, Francis E; Frankel, David S; Cooper, Joshua M; Supple, Gregory; Deo, Rajat; Verdino, Ralph J; Patel, Vickas V; Dixit, Sanjay
Arrhythmia monitoring in patients undergoing atrial fibrillation (AF) ablation is challenging. Transtelephonic monitors (TTMs) are cumbersome to use and provide limited temporal assessment. Implantable loop recorders (ILRs) may overcome these limitations. We sought to evaluate the utility of ILRs versus conventional monitoring (CM) in patients undergoing AF ablation. Forty-four patients undergoing AF ablation received ILRs and CM (30-day TTM at discharge and months 5 and 11 postablation). Over the initial 6 months, clinical decisions were made based on CM. Subjects were then randomized for the remaining 6 months to arrhythmia assessment and management by ILR versus CM. The primary endpoint was arrhythmia recurrence. The secondary endpoint was actionable clinical events (change of antiarrhythmic drugs [AADs], anticoagulation, non-AF arrhythmia events, etc.) due to either monitoring strategy. Over the study period, 6 patients withdrew. In the first 6 months, AF recurred in 18 patients (7 noted by CM, 18 by ILR; P = 0.002). Five patients in the CM (28%) and 5 in the ILR arm (25%; P = NS) had AF recurrence during the latter 6 months. AF was falsely diagnosed frequently by ILR (730 of 1,421 episodes; 51%). In more patients in the ILR compared with the CM arm, rate control agents (60% vs 39%, P = 0.02) and AADs (71% vs 44%, P = 0.04) were discontinued. In AF ablation patients, ILR can detect more arrhythmias than CM. However, false detection remains a challenge. With adequate oversight, ILRs may be useful in monitoring these patients after ablation. © 2013 Wiley Periodicals, Inc.
Ratanawongsa, Neda; Matta, George Y; Bohsali, Fuad B; Chisolm, Margaret S
Clinicians' use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians' EHR workload, stress, and burnout. We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with "misses" (errors that were not caught at the time) or "near misses" (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about "misses we don't even know about." Risk factors included the computer's position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR
Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline
To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.
Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas
To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its
Oluoch, Tom; Kwaro, Daniel; Ssempijja, Victor; Katana, Abraham; Langat, Patrick; Okeyo, Nicky; Abu-Hanna, Ameen; de Keizer, Nicolette
The monitoring of pre-antiretroviral therapy (pre-ART) is a key indicator of HIV quality of care. This study investigated the association of an electronic medical record system (EMR) with adherence to pre-ART guidelines in rural HIV clinics in Kenya. A retrospective study was carried out to assess
densirostris) off the coast of El Hierro in the Canary Islands. A tag was deployed with relative ease on an adult beaked whale which proceeded to carry it for...located off-shore of El Hierro by chance. On examination, we found that water ingress had again caused failure of the recording circuit early in the
J.P. Velema (Johan)
textabstractSince the introduction of the string galvanometer by Einthoven (1901), various instruments have been developed (a technical review is given by Dunn & Rahm, 1950) to record the so-called electrocardiogram (ECG). Physical activity, changes in position and certain bodily functions such as
Joukes, Erik; Cornet, Ronald; Abu-Hanna, Ameen; de Bruijne, Martine; de Keizer, Nicolette
Implementing an Electronic Health Record (EHR) is a sociotechnical process. End-users' expectations and attitudes need to be monitored during the implementation of a new EHR. It is not clear what end-users consider the most important determinants (both barriers and enablers for a successful EHR
McInnes D Keith
Full Text Available Abstract Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising
McInnes, D Keith; Solomon, Jeffrey L; Bokhour, Barbara G; Asch, Steven M; Ross, David; Nazi, Kim M; Gifford, Allen L
When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system. We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory.Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of patients getting
Triebwasser, Corey; Wang, Rong; DeWan, Andrew T; Metayer, Catherine; Morimoto, Libby; Wiemels, Joseph L; Kadan-Lottick, Nina; Ma, Xiaomei
To evaluate the relationship between birth weight (along with a variety of pre and perinatal characteristics) and the risk of paediatric Hodgkin lymphoma (HL) diagnosed at age birth records from 1978-2009 and cancer diagnosis data from 1988-2011 to conduct a population-based case-control study with 1216 cases and 4485 controls (matched on birth month and year, sex, and race/ethnicity). Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of paediatric HL overall and by age of diagnosis, controlling for other perinatal factors. Compared to children with a normal birth weight (2500-3999 g), those who had a high birth weight (≥4000 g) had an increased risk of paediatric HL overall (OR = 1.23, 95% CI: 1.02-1.48) after adjusting for birth order, maternal age at the time of delivery, and paternal age at the time of delivery. The magnitude of association appeared larger for subgroups of children whose age of diagnosis was 0-10 years (OR = 1.56, 95% CI: 1.04-2.24) or 15-19 years (OR = 1.43, 95% CI: 1.11-1.83), while no association was observed in 11-14 year olds. Compared with firstborn children, those who were third or higher in birth order had a reduced risk of paediatric HL overall (OR = 0.80, 95% CI: 0.67-0.95), and this association also varied by age of diagnosis. In this study with the largest number of paediatric HL cases, high birth weight was associated with an increased disease risk for most but not all ages of diagnosis. The different findings by age of diagnosis regarding both birth weight and birth order underscore the importance to stratify paediatric HL by age at diagnosis in future etiological investigations. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
El Aarbaoui, Tarik; Méline, Julie; Brondeel, Ruben; Chaix, Basile
Studies revealed long-term associations between noise exposure and cardiovascular health, but the underlying short-term mechanisms remain uncertain. To explore the concomitant and lagged short-term associations between personal exposure to noise and heart rate variability (HRV) in a real life setting in the Île-de-France region. The RECORD MultiSensor Study collected between July 2014 and June 2015 noise and heart rate data for 75 participants, aged 34-74 years, in their living environments for 7 days using a personal dosimeter and electrocardiography (ECG) sensor on the chest. HRV parameters and noise levels were calculated for 5-min windows. Short-term relationships between noise level and log-transformed HRV parameters were assessed using mixed effects models with a random intercept for participants and a temporal autocorrelation structure, adjusted for heart rate, physical activity (accelerometry), and short-term trends. An increase by one dB(A) of A-weighted equivalent sound pressure level (Leq) was associated with a 0.97% concomitant increase of the Standard deviation of normal to normal intervals (SDNN) (95% CI: 0.92, 1.02), of 2.08% of the Low frequency band power (LF) (95% CI: 1.97, 2.18), of 1.30% of the High frequency band power (HF) (95% CI: 1.17, 1.43), and of 1.16% of the LF/HF ratio (95% CI: 1.10, 1.23). The analysis of lagged exposures to noise adjusted for the concomitant exposure illustrates the dynamic of recovery of the autonomic nervous system. Non-linear associations were documented with all HRV parameters with the exception of HF. Piecewise regression revealed that the association was almost 6 times stronger below than above 65 Leq dB(A) for the SDNN and LF/HF ratio. Personal noise exposure was found to be related to a concomitant increase of the overall HRV, with evidence of imbalance of the autonomic nervous system towards sympathetic activity, a pathway to increased cardiovascular morbidity and mortality. Copyright © 2017 Elsevier Ltd
Hoogenboom, Wouter S.; Perlis, Roy H.; Smoller, Jordan W.; Zeng-Treitler, Qing; Gainer, Vivian S.; Murphy, Shawn N.; Churchill, Susanne E.; Kohane, Isaac S.; Shenton, Martha E.; Iosifescu, Dan V.
For certain research questions related to long-term outcomes or to rare disorders, designing prospective studies is impractical or prohibitively expensive. Such studies could instead utilize clinical and magnetic resonance imaging data (MRI) collected as part of routine clinical care, stored in the electronic medical record (EMR). Using major depressive disorder (MDD) as a disease model, we examined the feasibility of studying brain morphology and associations with remission using clinical and MRI data exclusively drawn from the EMR. Advanced automated tools were used to select MDD patients and controls from the EMR who had brain MRI data, but no diagnosed brain pathology. MDD patients were further assessed for remission status by review of clinical charts. Twenty MDD patients (eight full-remitters, six partial-remitters, and six non-remitters), and fifteen healthy control subjects met all study criteria for advanced morphometric analyses. Compared to controls, MDD patients had significantly smaller right rostral-anterior cingulate volume, and level of non-remission was associated with smaller left hippocampus and left rostral-middle frontal gyrus volume. The use of EMR data for psychiatric research may provide a timely and cost-effective approach with the potential to generate large study samples reflective of the real population with the illness studied. PMID:23149041
... teams, and summer camps or to travel. Recording Immunizations Good record- keeping begins with good record- taking. ... to each visit with his doctor. Finding Official Immunization Records CDC does not have immunization record information. ...
Clair L. Firth
Full Text Available Background Antimicrobial use in livestock production is an important contemporary issue, which is of public interest worldwide. Antimicrobials are not freely available to Austrian farmers and can only be administered to livestock by veterinarians, or by farmers who are trained members of the Animal Health Service. Since 2015, veterinarians have been required by law to report antimicrobials dispensed to farmers for use in food-producing animals. The study presented here went further than the statutory framework, and collected data on antimicrobials dispensed to farmers and those administered by veterinarians. Methods Seventeen veterinary practices were enrolled in the study via convenience sampling. These veterinarians were asked to contact interested dairy farmers regarding participation in the study (respondent-driven sampling. Data were collected from veterinary practice software between 1st October 2015 and 30th September 2016. Electronic data (89.4% were transferred via an online interface and paper records (10.6% were entered by the authors. Antimicrobial treatments with respect to udder disease were analysed by number of defined daily doses per cow and year (nDDDvet/cow/year, based on the European Medicines Agency technical unit, Defined Daily Dose for animals (DDDvet. Descriptive statistics and the Wilcoxon rank sum test were used to analyse the results. Results Antimicrobial use data from a total of 248 dairy farms were collected during the study, 232 of these farms treated cows with antibiotics; dry cow therapy was excluded from the current analysis. The mean number of DDDvet/cow/year for the antimicrobial treatment of all udder disease was 1.33 DDDvet/cow/year. Of these treatments, 0.73 DDDvet/cow/year were classed as highest priority critically important antimicrobials (HPCIAs, according to the World Health Organization (WHO definition. The Wilcoxon rank sum test determined a statistically significant difference between the median
Brázdil, R.; Chromá, K.; Řezníčková, L.; Valášek, H.; Dolák, L.; Stachoň, Z.; Soukalová, E.; Dobrovolný, P.
Since the second half of the 17th century, tax relief has been available to farmers and landowners to offset flood damage to property (buildings) and land (fields, meadows, pastures, gardens) in South Moravia, Czech Republic. Historically, the written applications for this were supported by a relatively efficient bureaucratic process that left a clear data trail of documentation, preserved at several levels: in the communities affected, in regional offices, and in the Moravian Land Office, all of which are to be found in estate and family collections in the Moravian Land Archives in the city of Brno, the provincial capital. As well as detailed information about damage done and administrative responses to it, data is often preserved as to the flood event itself, the time of its occurrence and its impacts, sometimes together with causes and stages. The final flood database based on taxation records is used here to describe the temporal and spatial density of both flood events and the records themselves. The information derived is used to help create long-term flood chronologies for the Rivers Dyje, Jihlava, Svratka and Morava, combining floods interpreted from taxation records with other documentary data and floods derived from later systematic hydrological measurements (water levels, discharges). Common periods of higher flood frequency appear largely in 1821-1850 and 1921-1950, although this shifts to several other decades for individual rivers. Certain uncertainties are inseparable from flood data taxation records: their spatial and temporal incompleteness; the inevitable limitation to larger-scale damage and to the summer half-year; and the different characters of rivers, including land-use changes and channel modifications. Taxation data has great potential for extending our knowledge of past floods for the rest of the Czech Republic as well, not to mention other European countries in which records have survived.
Sayers, Adrian; Ben-Shlomo, Yoav; Blom, Ashley W; Steele, Fiona
Studies involving the use of probabilistic record linkage are becoming increasingly common. However, the methods underpinning probabilistic record linkage are not widely taught or understood, and therefore these studies can appear to be a 'black box' research tool. In this article, we aim to describe the process of probabilistic record linkage through a simple exemplar. We first introduce the concept of deterministic linkage and contrast this with probabilistic linkage. We illustrate each step of the process using a simple exemplar and describe the data structure required to perform a probabilistic linkage. We describe the process of calculating and interpreting matched weights and how to convert matched weights into posterior probabilities of a match using Bayes theorem. We conclude this article with a brief discussion of some of the computational demands of record linkage, how you might assess the quality of your linkage algorithm, and how epidemiologists can maximize the value of their record-linked research using robust record linkage methods. © The Author 2015; Published by Oxford University Press on behalf of the International Epidemiological Association.
Gómez-González, J F; Destexhe, A; Bal, T
Electrophysiological recordings of single neurons in brain tissues are very common in neuroscience. Glass microelectrodes filled with an electrolyte are used to impale the cell membrane in order to record the membrane potential or to inject current. Their high resistance induces a high voltage drop when passing current and it is essential to correct the voltage measurements. In particular, for voltage clamping, the traditional alternatives are two-electrode voltage-clamp technique or discontinuous single electrode voltage-clamp (dSEVC). Nevertheless, it is generally difficult to impale two electrodes in a same neuron and the switching frequency is limited to low frequencies in the case of dSEVC. We present a novel fully computer-implemented alternative to perform continuous voltage-clamp recordings with a single sharp-electrode. To reach such voltage-clamp recordings, we combine an active electrode compensation algorithm (AEC) with a digital controller (AECVC). We applied two types of control-systems: a linear controller (proportional plus integrative controller) and a model-based controller (optimal control). We compared the performance of the two methods to dSEVC using a dynamic model cell and experiments in brain slices. The AECVC method provides an entirely digital method to perform continuous recording and smooth switching between voltage-clamp, current clamp or dynamic-clamp configurations without introducing artifacts.
Full Text Available Spiking models can accurately predict the spike trains produced by cortical neurons in response to somatically injected currents. Since the specific characteristics of the model depend on the neuron, a computational method is required to fit models to electrophysiological recordings. The fitting procedure can be very time consuming both in terms of computer simulations and in terms of code writing. We present algorithms to fit spiking models to electrophysiological data (time-varying input and spike trains that can run in parallel on graphics processing units (GPUs. The model fitting library is interfaced with Brian, a neural network simulator in Python. If a GPU is present it uses just-in-time compilation to translate model equations into optimized code. Arbitrary models can then be defined at script level and run on the graphics card. This tool can be used to obtain empirically validated spiking models of neurons in various systems. We demonstrate its use on public data from the INCF Quantitative Single-Neuron Modeling 2009 competition by comparing the performance of a number of neuron spiking models.
The magnetic storage areal density keeps increasing every year, and magnetic recording-based hard disk drives provide a very cheap and effective solution to the ever increasing demand for data storage. Heat assisted magnetic recording (HAMR) and bit patterned media have been proposed to increase the magnetic storage density beyond 1 Tb/in2. In HAMR systems, high magnetic anisotropy materials are recommended to break the superparamagnetic limit for further scaling down the size of magnetic bits. However, the current magnetic transducers are not able to generate strong enough field to switch the magnetic orientations of the high magnetic anisotropy material so the data writing is not able to be achieved. So thermal heating has to be applied to reduce the coercivity for the magnetic writing. To provide the heating, a laser is focused using a near field transducer (NFT) to locally heat a ~(25 nm)2 spot on the magnetic disk to the Curie temperature, which is ~ 400 C-600°C, to assist in the data writing process. But this high temperature working condition is a great challenge for the traditional head-disk interface (HDI). The disk lubricant can be depleted by evaporation or decomposition. The protective carbon overcoat can be graphitized or oxidized. The surface quality, such as its roughness, can be changed as well. The NFT structure is also vulnerable to degradation under the large number of thermal load cycles. The changes of the HDI under the thermal conditions could significantly reduce the robustness and reliability of the HAMR products. In bit patterned media systems, instead of using the continuous magnetic granular material, physically isolated magnetic islands are used to store data. The size of the magnetic islands should be about or less than 25 nm in order to achieve the storage areal density beyond 1 Tb/in2. However, the manufacture of the patterned media disks is a great challenge for the current optical lithography technology. Alternative lithography
Padrez, Kevin A; Ungar, Lyle; Schwartz, Hansen Andrew; Smith, Robert J; Hill, Shawndra; Antanavicius, Tadas; Brown, Dana M; Crutchley, Patrick; Asch, David A; Merchant, Raina M
Social media may offer insight into the relationship between an individual's health and their everyday life, as well as attitudes towards health and the perceived quality of healthcare services. To determine the acceptability to patients and potential utility to researchers of a database linking patients' social media content with their electronic medical record (EMR) data. Adult Facebook/Twitter users who presented to an emergency department were queried about their willingness to share their social media data and EMR data with health researchers for the purpose of building a databank for research purposes. Shared posts were searched for select terms about health and healthcare. Of the 5256 patients approached, 2717 (52%) were Facebook and/or Twitter users. 1432 (53%) of those patients agreed to participate in the study. Of these participants, 1008 (71%) consented to share their social media data for the purposes of comparing it with their EMR. Social media data consisted of 1 395 720 posts/tweets to Facebook and Twitter. Participants sharing social media data were slightly younger (29.1±9.8 vs 31.9±10.4 years old; ppost at least once a day (42% vs 29%; p=0.003) and more likely to present to the emergency room via self-arrival mode and have private insurance. Of Facebook posts, 7.5% (95% CI 4.8% to 10.2%) were related to health. Individuals with a given diagnosis in their EMR were significantly more likely to use terms related to that diagnosis on Facebook than patients without that diagnosis in their EMR (p<0.0008). Many patients are willing to share and link their social media data with EMR data. Sharing patients have several demographic and clinical differences compared with non-sharers. A database that merges social media with EMR data has the potential to provide insights about individuals' health and health outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Redd, Andrew M; Gundlapalli, Adi V; Divita, Guy; Carter, Marjorie E; Tran, Le-Thuy; Samore, Matthew H
and text that was extraneous. Major obstacles to improved performance included documents composed of multiple templates, templates that included other templates embedded within them, and variants of templates. We demonstrate proof of concept of the grouping and extraction method of identifying templates in electronic medical records in this pilot study and propose methods to improve performance and scaling up. Published by Elsevier Inc.
Iolov, Alexandre; Ditlevsen, Susanne; Longtin, Andrë
stimulation of a neuron to achieve a target spike train under the physiological constraint to not damage tissue. Approach. We pose a stochastic optimal control problem to precisely specify the spike times in a leaky integrate-and-fire (LIF) model of a neuron with noise assumed to be of intrinsic or synaptic...... to the spike times (open-loop control). Main results. We have developed a stochastic optimal control algorithm to obtain precise spike times. It is applicable in both the supra-threshold and sub-threshold regimes, under open-loop and closed-loop conditions and with an arbitrary noise intensity; the accuracy...... into account physiological constraints on the control. A precise and robust targeting of neural activity based on stochastic optimal control has great potential for regulating neural activity in e.g. prosthetic applications and to improve our understanding of the basic mechanisms by which neuronal firing...
In this issue of Neuron, Rossi-Pool et al. (2017) show that the complex and heterogeneous response profiles of individual neurons in the dorsal premotor cortex during comparison of tactile temporal patterns can be understood in terms of two robust activity patterns that emerge across the population. Copyright © 2017 Elsevier Inc. All rights reserved.
Arcas, Blaise Aguera y; Fairhall, Adrienne L.; Bialek, William
A spiking neuron ``computes'' by transforming a complex dynamical input into a train of action potentials, or spikes. The computation performed by the neuron can be formulated as dimensional reduction, or feature detection, followed by a nonlinear decision function over the low dimensional space. Generalizations of the reverse correlation technique with white noise input provide a numerical strategy for extracting the relevant low dimensional features from experimental data, and information t...
JUAN DAVID VELÁSQUEZ HENAO
Full Text Available La combinación de modelos SARIMA y redes neuronales son una aproximación común para pronosticar series de tiempo no lineales. Mientras la metodología SARIMA es usada para capturar las componentes lineales en la serie de tiempo, las redes neuronales artiﬁ ciales son aplicadas para pronosticar las no-linealidades remanentes en los residuos del modelo SARIMA. En este artículo, se propone un modelo simple no lineal para el pronóstico de series de tiempo obtenido por la combinación de un modelo SARIMA y una neurona simple multiplicativa que usa las mismas entradas del modelo SARIMA. Para evaluar la capacidad de la nueva aproximación, la demanda mensual de electricidad en el mercado de energía de Colombia es pronosticada y comparada con los modelos SARIMA y la neurona simple multiplicativa.
Sonoo, Tomohiro; Iwai, Satoshi; Inokuchi, Ryota; Gunshin, Masataka; Kitsuta, Yoichi; Nakajima, Susumu
Along with article-based checklists, structured template recording systems have been reported as useful to create more accurate clinical recording, but their contributions to the improvement of the quality of patient care have been controversial. An emergency department (ED) must manage many patients in a short time. Therefore, such a template might be especially useful, but few ED-based studies have examined such systems.A structured template produced according to widely used head injury guidelines was used by ED residents for head injury patients. The study was conducted by comparing each 6-month period before and after launching the system. The quality of the patient notes and factors recorded in the patient notes to support the head computed tomography (CT) performance were evaluated by medical students blinded to patient information.The subject patients were 188 and 177 in respective periods. The numbers of patient notes categorized as "CT indication cannot be determined" were significantly lower in the postintervention term (18% → 9.0%), which represents the patient note quality improvement. No difference was found in the rates of CT performance or CT skip without clearly recorded CT indication in the patient notes.The structured template functioned as a checklist to support residents in writing more appropriately recorded patient notes in the ED head injury patients. Such a template customized to each clinical condition can facilitate standardized patient management and can improve patient safety in the ED.
Lee, Theresa M; Tu, Karen; Wing, Laura L; Gershon, Andrea S
Little is known about using electronic medical records to identify patients with chronic obstructive pulmonary disease to improve quality of care. Our objective was to develop electronic medical record algorithms that can accurately identify patients with obstructive pulmonary disease. A retrospective chart abstraction study was conducted on data from the Electronic Medical Record Administrative data Linked Database (EMRALD ® ) housed at the Institute for Clinical Evaluative Sciences. Abstracted charts provided the reference standard based on available physician-diagnoses, chronic obstructive pulmonary disease-specific medications, smoking history and pulmonary function testing. Chronic obstructive pulmonary disease electronic medical record algorithms using combinations of terminology in the cumulative patient profile (CPP; problem list/past medical history), physician billing codes (chronic bronchitis/emphysema/other chronic obstructive pulmonary disease), and prescriptions, were tested against the reference standard. Sensitivity, specificity, and positive/negative predictive values (PPV/NPV) were calculated. There were 364 patients with chronic obstructive pulmonary disease identified in a 5889 randomly sampled cohort aged ≥ 35 years (prevalence = 6.2%). The electronic medical record algorithm consisting of ≥ 3 physician billing codes for chronic obstructive pulmonary disease per year; documentation in the CPP; tiotropium prescription; or ipratropium (or its formulations) prescription and a chronic obstructive pulmonary disease billing code had sensitivity of 76.9% (95% CI:72.2-81.2), specificity of 99.7% (99.5-99.8), PPV of 93.6% (90.3-96.1), and NPV of 98.5% (98.1-98.8). Electronic medical record algorithms can accurately identify patients with chronic obstructive pulmonary disease in primary care records. They can be used to enable further studies in practice patterns and chronic obstructive pulmonary disease management in primary care. NOVEL
Nagata, Takashi; Halamka, John; Himeno, Shinkichi; Himeno, Akihiro; Kennochi, Hajime; Hashizume, Makoto
Following the Great East Japan Earthquake on March 11, 2011, the Japan Medical Association deployed medical disaster teams to Shinchi-town (population: approximately 8,000), which is located 50 km north of the Fukushima Daiichi nuclear power plant. The mission of the medical disaster teams sent from Fukuoka, 1,400 km south of Fukushima, was to provide medical services and staff a temporary clinic for six weeks. Fear of radiation exposure restricted the use of large medical teams and local infrastructure. Therefore, small volunteer groups and a cloud-hosted, web-based electronic health record were implemented. The mission was successfully completed by the end of May 2011. Cloud-based electronic health records deployed using a "software as a service" model worked well during the response to the large-scale disaster.
Al Shammary, Nawaf; Asimakopoulou, Koula; McDonald, Fraser; Newton, Jonathon T; Scambler, Sasha
Nawaf Al Shammary,1 Koula Asimakopoulou,1 Fraser McDonald,2 Jonathon T Newton,1 Sasha Scambler1 1Division of Population and Patient Health, 2Craniofacial Development and Stem Cell Biology Department, King’s College London Dental Institute, London, UKBackground: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adhe...
Greysen, S Ryan; Magan Mendoza, Yimdriuska; Rosenthal, Jaime; Jacolbia, Ronald; Rajkomar, Alvin; Lee, Herman; Auerbach, Andrew
Background Inadequate patient engagement in care is a major barrier to successful transitions from the inpatient setting and can lead to preventable adverse events after discharge, particularly for older adults. While older adults may be less familiar with mobile devices and applications, they may benefit from focused bedside training to engage them in using their Personal Health Record (PHR). Mobile technologies such as tablet computers can be used in the hospital to help bridge this gap in ...
Gulliford, Martin C; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Charlton, Judith; Dregan, Alex
There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for
Background The patient handover is important for the safe transition from the pre-hospital setting to secondary care. The loss of critical information about the pre-hospital phase may impact upon the clinical course of the patient. Methods University Hospital Emergency Care registrars answered a questionnaire about how they perceive clinical documentation from the ambulance services. We also reviewed patient records retrospectively, to investigate to what extent eight selected parameters were transferred correctly to hospital records by clinicians. Only parameters outside the normal range were selected. Results The registrars preferred a verbal handover with hand-written pre-hospital reports as the combined source of clinical information. Scanned report forms were infrequently used. Information from other doctors was perceived as more important than the information from ambulance crews. Less than half of the selected parameters in pre-hospital notes were transferred to hospital records, even for parameters regarded as important by the registrars. Abnormal vital signs were not transferred as often as mechanism of injury, medication administered and immobilisation of trauma patients. Conclusions Data on pre-hospital abnormal vital signs are frequently not transferred to the hospital admission notes. This information loss may lead to suboptimal care. PMID:23453123
Liu, Xiaodong; Jiang, Shan; Zhang, Pengfei; Xu, Liqiang
Historical changes of anthropogenic Pb pollution were reconstructed based on Pb concentrations and isotope ratios in lake and peat sediment profiles from Ny-Ålesund of Arctic. The calculated excess Pb isotope ratios showed that Pb pollution largely came from west Europe and Russia. The peat profile clearly reflected the historical changes of atmospheric deposition of anthropogenic Pb into Ny-Ålesund, and the result showed that anthropogenic Pb peaked at 1960s-1970s, and thereafter a significant recovery was observed by a rapid increase of (206)Pb/(207)Pb ratios and a remarkable decrease in anthropogenic Pb contents. In contrast to the peat record, the longer lake record showed relatively high anthropogenic Pb contents and a persistent decrease of (206)Pb/(207)Pb ratios within the uppermost samples, suggesting that climate-sensitive processes such as catchment erosion and meltwater runoff might have influenced the recent change of Pb pollution record in the High Arctic lake sediments. Copyright Â© 2011 Elsevier Ltd. All rights reserved.
This document consists of viewgraphs from the presentations at the conference. Topics included are: DOE records management overview, NIRMA and ARMA resources, NARA records management training, potential quality assurance records, filing systems, organizing and indexing technical records, DOE-HQ initiatives, IRM reviews, status of epidemiologic inventory, disposition of records and personal papers, inactive records storage, establishing administrative records, managing records at Hanford, electronic mail -- legal and records issues, NARA-GAO reports status, consultive selling, automated indexing, decentralized approach to scheduling at a DOE office, developing specific records management programs, storage and retrieval at Savannah River Plant, an optical disk case study, and special interest group reports.
Strano, S. E.; Stoner, J. S.; Almasi, P. F.; Bond, G.
Deep-sea sediments, particularly those from the North Atlantic, have been instrumental in the development of modern paleomagnetic concepts. However, accuracy of these sediments as geomagnetic recorders has never been explicitly tested with implications for stratigraphic correlations, geodynamo constraints and assessing controls on cosmogenic isotope production. Here we present u-channel paleomagnetic records from five high-resolution (~15-55 cm/kyr) deep-sea sediment cores taken from across the North Atlantic. KN-158-04-2GC (43°29'N, 54°52'W, 3942 m) and KN-158-04-22GC (44°18'N, 46°15'W, 3959 m) were taken from the New Foundland Margin and the New Foundland Basin. While cores KN-158-04-53GC (55°27'N, 14°42'W, 2184 m), KN-158-04-46GC (52°58'N, 19°49'W, 2758 m) and KN-158-04-57GC (58°39'N, 25°25'W, 2768 m) are from the Feni Drift, Rockall Trough and Iceland Basin, respectively. Progressive alternating field demagnetization indicates that all cores preserve a strong, stable, low coercivity magnetization consistent with magnetite as the remanence carrier. Well-resolved component directions as indicated by low MAD values (often <1), define a characteristic remanent magnetization (ChRM) with inclinations expected for the sites latitudes. Normalized remanence records are consistent using different normalizers (e.g. ARM, IRM, k), while passing all other criteria to be considered reliable relative paleointensity (RPI) estimates. In general these would be considered high quality PSV and RPI records. Here we use well-constrained radiocarbon based chronologies to compare these records with high-quality regional geomagnetic archives to assess how these sediments preserve geomagnetic signals. Assuming our geomagnetic templates are valid across the North Atlantic, initial analyses suggest a linear relationship between PSV amplitude and sedimentation rate. Even our highest-resolution cores show a significant loss of amplitude as compared to the template, thereby
Kato, Kumiko; Kondo, Mineo; Nagashima, Ryunosuke; Sugawara, Asako; Sugimoto, Masahiko; Matsubara, Hisashi; McCulloch, Daphne L; Ikesugi, Kengo
A small, full-field flicker electroretinogram (ERG) recording system was recently developed to record flicker ERGs without mydriasis (RETeval). The device delivers a stimulus with constant retinal illuminance by adjusting the retinal luminance to compensate for changes in the pupillary area. The purpose of this study was to determine what factors affect the fundamental components of the flicker ERGs recorded by RETeval in young healthy subjects. Flicker ERGs were recorded with the RETeval system from 150 eyes of 150 young healthy subjects (age, 20-29 years). Univariate and multivariate linear regression analyses were performed to identify the factors that affected the implicit times and amplitudes of the fundamental component of the flicker ERGs. The independent variables included age, sex, refractive error, axial length, and pupillary area. Multivariate regression analyses indicated that a longer axial length (P = 0.03) and larger pupillary area (P = 0.008) were independent factors that were significantly associated with longer implicit times of the fundamental component of the flicker ERGs. Multivariate regression analyses also showed that the female sex (P = 0.03) was an independent factor, which was significantly associated with larger amplitude fundamental component of the flicker ERGs. These results indicate that the fundamental components of the RETeval flicker ERGs are significantly affected by the axial length, pupillary area, and sex of young healthy subjects. The results also suggest that it would be better to compensate for the Stiles-Crawford effect when flicker ERGs are recorded with natural pupils.
Full Text Available The purpose of this study is to understand which bibliographic data are the core elements of the user’s queries? What users’ viewpoints about resource descriptions using different metadata standards? What kinds of value-added items are the users’ favorite when they conduct a bibliographic search? What are users’ viewpoints about bibliographic records integrated with the Digital Archival and Institutional Repository resources through metadata interoperability methods? This research adopted experiments, observation and interviews. The sample subjects are drawn from 14 students of The Graduate Institute of Library and Information Science and College of Agriculture and Natural Resources. First of all, the researcher displayed the bibliographic records using original MARC from the library. Secondly, users compared the images of OPAC from the library with the format of DC and MODS transformed through the MarcEdit software. Additionally, the researcher conducted interviews to understand users’ viewpoints about using three metadata schemas to describe the same book. Finally, the researcher asked the degree of users’ satisfaction about using bibliographic records alone and bibliographic records integrated with the Digital Archival and Institutional Repository resources. The findings suggest that libraries could provide more value-added and comprehensive services of bibliographic records and information retrieval, in order for all kinds of resources to be fully utilized, which helps to meet the users’ information needs.
G-J.P. Kimman (Geert-Jan); D.A.M.J. Theuns (Dominic); P. Janse (Petter); M. Rivero-Ayerza (Maximo); M.F. Scholten (Marcoen); T. Szili-Torok (Tamas); L.J.L.M. Jordaens (Luc)
textabstractAims: To rely solely on clinical symptoms of recurrent palpitations to evaluate the success of interventional procedures can be misleading. This study was designed to assess the efficacy of event recording in evaluating long-term success in patients treated for atrioventricular nodal
Janssen, E.H.C.; Ven, P.M. van de; Terluin, B.; Verhaak, P.F.M.; Marwijk, H.W.J. van; Smolders, M.; Meer, K. van der; Penninx, B.W.J.H.; Hout, H.P.J. van
Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient
Janssen, E.H.C.; van de Ven, P.M.; Terluin, B.; Verhaak, P.F.M.; van Marwijk, H.W.J.; Smolders, M.; van der Meer, K.; Penninx, B.W.J.H.; van Hout, H.P.J.
Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient
Donker, G.A.; Velden, P.G. van der; Kerssens, J.J.; Yzermans, C.J.
Objective: To assess the characteristics and implications for care of infrequent attendance in general practice in the aftermath of disaster. Methods: A study of the content of electronic medical records (EMRs) in pre- and post-disaster periods linked to an enquiry using self-reported questionnaires
Donker, G.; van der Velden, P.G.; Kerssens, J.; Yzermans, C.J.
Objective. To assess the characteristics and implications for care of infrequent attendance in general practice in the aftermath of disaster. Methods. A study of the content of electronic medical records (EMRs) in pre- and post-disaster periods linked to an enquiry using self-reported questionnaires
Spil, Antonius A.M.; Schuring, R.W.; Stegwee, R.A.; Michel-Verkerke, Margreet B.
This paper compares a traditional requirements study with 22 interviews for the design of an electronic patient record (EPR) and a USE IT analysis with 17 interviews trying to understand the end- user of an EPR. Developing, implementing and using information technology in organizations is a complex
Gulliford, Martin C; van Staa, Tjeerd; Dregan, Alex; McDermott, Lisa; McCann, Gerard; Ashworth, Mark; Charlton, Judith; Little, Paul; Moore, Michael V; Yardley, Lucy
PURPOSE: This study aimed to implement a point-of-care cluster randomized trial using electronic health records. We evaluated the effectiveness of electronically delivered decision support tools at reducing antibiotic prescribing for respiratory tract infections in primary care. METHODS: Family
Wright, Adam; McCoy, Allison B; Hickman, Thu-Trang T; Hilaire, Daniel St; Borbolla, Damian; Bowes, Watson A; Dixon, William G; Dorr, David A; Krall, Michael; Malholtra, Sameer; Bates, David W; Sittig, Dean F
To assess problem list completeness using an objective measure across a range of sites, and to identify success factors for problem list completeness. We conducted a retrospective analysis of electronic health record data and interviews at ten healthcare organizations within the United States, United Kingdom, and Argentina who use a variety of electronic health record systems: four self-developed and six commercial. At each site, we assessed the proportion of patients who have diabetes recorded on their problem list out of all patients with a hemoglobin A1c elevation>=7.0%, which is diagnostic of diabetes. We then conducted interviews with informatics leaders at the four highest performing sites to determine factors associated with success. Finally, we surveyed all the sites about common practices implemented at the top performing sites to determine whether there was an association between problem list management practices and problem list completeness. Problem list completeness across the ten sites ranged from 60.2% to 99.4%, with a mean of 78.2%. Financial incentives, problem-oriented charting, gap reporting, shared responsibility, links to billing codes, and organizational culture were identified as success factors at the four hospitals with problem list completeness at or near 90.0%. Incomplete problem lists represent a global data integrity problem that could compromise quality of care and put patients at risk. There was a wide range of problem list completeness across the healthcare facilities. Nevertheless, some facilities have achieved high levels of problem list completeness, and it is important to better understand the factors that contribute to success to improve patient safety. Problem list completeness varies substantially across healthcare facilities. In our review of EHR systems at ten healthcare facilities, we identified six success factors which may be useful for healthcare organizations seeking to improve the quality of their problem list
Zhao, Min; Cooney, Marie Therese; Klipstein-Grobusch, Kerstin; Vaartjes, Ilonca; De Bacquer, Dirk; De Sutter, Johan; Reiner, Željko; Prescott, Eva; Faggiano, Pompilio; Vanuzzo, Diego; AlFaleh, Hussam; Menown, Ian Ba; Gait, Dan; Posogova, Nana; Sheu, Wayne H-H; Zhao, Dong; Zuo, Huijuan; Grobbee, Diederick E; Graham, Ian M
To simplify the assessment of the recording and control of coronary heart disease risk factors in different countries and regions. The SUrvey of Risk Factors (SURF) is an international clinical audit. Data on consecutive patients with established coronary heart disease from countries in Europe, Asia and the Middle East were collected on a one-page collection sheet or electronically during routine clinic visits. Information on demographics, diagnostic category, risk factors, physical and laboratory measurements, and medications were included and key variables summarized in a Cardiovascular Health Index Score. Coronary heart disease patients (N = 10,186; 29% women) were enrolled from 79 centres in 11 countries. Recording of risk factors varied considerably: smoking was recorded in over 98% of subjects, while about 20% lacked data on laboratory measurements relevant to cardiovascular disease risk. Sixteen per cent of participants reported smoking, 29% were obese, and 46% had abdominal obesity. Sixty per cent of participants had blood pressure <140/90 mmHg (140/80 mmHg for diabetics), 48% had HbA1c<7%, 30% had low-density lipoprotein <1.8 mmol/l and 17% had a good cardiovascular health index score. There were substantial regional variations. Less than 3% of patients attended cardiac rehabilitation in Asia or the Middle East, compared with 45% in Europe. In Asia, 15% of patients had low-density lipoprotein cholesterol <1.8 mmol/l compared with 33% in Europe and 36% in the Middle East. Variations in medications were noted, with lower use of statins in Asia. SURF proved to be practical in daily practice. Results indicated poor control of risk factors with substantial variation between countries, calling for development and implementation of clinical standards of secondary prevention of coronary heart disease. © The European Society of Cardiology 2016.
Full Text Available Abstract Background The structured admission form is an apparently simple measure to improve data quality. Poor motivation, lack of supervision, lack of resources and other factors are conceivably major barriers to their successful use in a Kenyan public hospital setting. Here we have examined the feasibility and acceptability of a structured paediatric admission record (PAR for district hospitals as a means of improving documentation of illness. Methods The PAR was primarily based on symptoms and signs included in the Integrated Management of Childhood Illness (IMCI diagnostic algorithms. It was introduced with a three-hour training session, repeated subsequently for those absent, aiming for complete coverage of admitting clinical staff. Data from consecutive records before (n = 163 and from a 60% random sample of dates after intervention (n = 705 were then collected to evaluate record quality. The post-intervention period was further divided into four 2-month blocks by open, feedback meetings for hospital staff on the uptake and completeness of the PAR. Results The frequency of use of the PAR increased from 50% in the first 2 months to 84% in the final 2 months, although there was significant variation in use among clinicians. The quality of documentation also improved considerably over time. For example documentation of skin turgor in cases of diarrhoea improved from 2% pre-intervention to 83% in the final 2 months of observation. Even in the area of preventive care documentation of immunization status improved from 1% of children before intervention to 21% in the final 2 months. Conclusion The PAR was well accepted by most clinicians and greatly improved documentation of features recommended by IMCI for identifying and classifying severity of common diseases. The PAR could provide a useful platform for implementing standard referral care treatment guidelines.
Ruano, Juan; Gómez-García, Francisco; Gay-Mimbrera, Jesús; Aguilar-Luque, Macarena; Fernández-Rueda, José Luis; Fernández-Chaichio, Jesús; Alcalde-Mellado, Patricia; Carmona-Fernandez, Pedro J; Sanz-Cabanillas, Juan Luis; Viguera-Guerra, Isabel; Franco-García, Francisco; Cárdenas-Aranzana, Manuel; Romero, José Luis Hernández; Gonzalez-Padilla, Marcelino; Isla-Tejera, Beatriz; Garcia-Nieto, Antonio Velez
Epidemiology and the reporting characteristics of systematic reviews (SRs) and meta-analyses (MAs) are well known. However, no study has analyzed the influence of protocol features on the probability that a study's results will be finally reported, thereby indirectly assessing the reporting bias of International Prospective Register of Systematic Reviews (PROSPERO) registration records. The objective of this study is to explore which factors are associated with a higher probability that results derived from a non-Cochrane PROSPERO registration record for a systematic review will be finally reported as an original article in a scientific journal. The PROSPERO repository will be web scraped to automatically and iteratively obtain all completed non-Cochrane registration records stored from February 2011 to December 2017. Downloaded records will be screened, and those with less than 90% fulfilled or are duplicated (i.e., those sharing titles and reviewers) will be excluded. Manual and human-supervised automatic methods will be used for data extraction, depending on the data source (fields of PROSPERO registration records, bibliometric databases, etc.). Records will be classified into published, discontinued, and abandoned review subgroups. All articles derived from published reviews will be obtained through multiple parallel searches using the full protocol "title" and/or "list reviewers" in MEDLINE/PubMed databases and Google Scholar. Reviewer, author, article, and journal metadata will be obtained using different sources. R and Python programming and analysis languages will be used to describe the datasets; perform text mining, machine learning, and deep learning analyses; and visualize the data. We will report the study according to the recommendations for meta-epidemiological studies adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for SRs and MAs. This meta-epidemiological study will explore, for the first time
The first workshop of the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT) was held on 4 October 2004. The workshop was hosted by the Japan Nuclear Energy Safety (JNES) Organization. The BFBT Benchmark is sponsored by the US Nuclear Regulatory Commission (NRC), the OECD, and the Nuclear Engineering Program (NEP) of the Pennsylvania State University. The experimental data was produced during a measurement campaign by the NUPEC, Japan, and sponsored by the Japan Ministry of Economy, Trade and Industry (METI). This international benchmark, based on the NUPEC database, encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactor's safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points are kept in mind while the benchmark specification is being established. As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have improved tremendously through the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark consists of two parts (phases), each part consisting of different exercises: - Phase 1 Void Distribution Benchmark: Exercise 1: Steady-state sub
The fourth workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-4) was held on 8 and 9 May 2007 at NEA Headquarters, Issy-les-Moulineaux, France. This international benchmark encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved through the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is made up of two parts (phases), each part consisting of different exercises: - Phase I Void Distribution Benchmark: Exercise 1 (I-1): Steady-state sub-channel grade benchmark; Exercise 2 (I-2): Steady-state microscopic grade benchmark; Exercise 3 (I-3): Transient macroscopic grade benchmark; Exercise 4 (I-4): Uncertainty analysis of the steady state sub-channel benchmark. - Phase II Critical Power Benchmark: Exercise 0 (II-0): Pressure drop benchmark; Exercise 1 (II-1): Steady-state benchmark; Exercise 2 (II-2): Transient benchmark
The fifth workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-5) was held on 31 March and 1 April 2008 in Garching, Germany. This international benchmark encourages advancement in the un-investigated fields of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is made up of two parts (phases), each part consisting of different exercises: - Phase I - Void Distribution Benchmark: Exercise 1 (I-1) - Steady-state sub-channel grade benchmark; Exercise 2 (I-2) - Steady-state microscopic grade benchmark; Exercise 3 (I-3) - Transient macroscopic grade benchmark; Exercise 4 (I-4) - Uncertainty analysis of the steady state sub-channel benchmark. - Phase II - Critical Power Benchmark: Exercise 0 (II-0) - Pressure drop benchmark; Exercise 1 (II-1) - Steady-state benchmark; Exercise 2 (II-2) - Transient benchmark; Exercise 3
The third workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-3) was held from 26 to 27 April 2006 in Pisa Italy. This international benchmark encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models for the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach applicable to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction are currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is composed of two parts (phases), each part consisting of different exercises: - Phase I Void Distribution Benchmark: Exercise 1 (I-1): Steady-state sub-channel grade benchmark; Exercise 2 (I-2): Steady-state microscopic grade benchmark; Exercise 3 (I-3): Transient macroscopic grade benchmark; Exercise 4 (I-4): Uncertainty analysis of the steady state sub-channel benchmark. - Phase II Critical Power Benchmark: Exercise 0 (II-0): Pressure drop benchmark; Exercise 1 (II-1): Steady-state benchmark; Exercise 2 (II-2): Transient benchmark; Exercise 3 (II-3): Uncertainty Analysis
The Sixth workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-6) was held on April 27-28 2009 in University Park / State College, PA, USA. This international benchmark encourages advancement in the un-investigated fields of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind while establishing the benchmark specification: As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark is made up of two parts (phases), each part consisting of different exercises: Phase I - Void Distribution Benchmark: Exercise 1 (I-1) - Steady-state sub-channel grade benchmark; Exercise 2 (I-2) - Steady-state microscopic grade benchmark; Exercise 3 (I-3) - Transient macroscopic grade benchmark; Exercise 4 (I-4) - Uncertainty analysis of the steady state sub-channel benchmark. Phase II - Critical Power Benchmark: Exercise 0 (II-0) - Pressure drop benchmark; Exercise 1 (II-1) - Steady-state benchmark; Exercise 2 (II-2) - Transient benchmark
The second workshop for the OECD/NRC Benchmark based on NUPEC BWR Full-size Fine-mesh Bundle Tests (BFBT-2) was held on 27-29 of June 2005 in University Park, PA, USA. This international benchmark, based on the NUPEC database, encourages advancement in this un-investigated field of two-phase flow theory with very important relevance to the nuclear reactors' safety margins evaluation. Considering the immaturity of the theoretical approach, the benchmark specification is being designed so that it systematically assesses and compares the participants' numerical models on the prediction of detailed void distributions and critical powers. Furthermore, the following points were kept in mind when establishing the benchmark specification. As concerns the numerical model of void distributions, no sound theoretical approach that can be applied to a wide range of geometrical and operating conditions has been developed. In the past decade, experimental and computational technologies have tremendously improved though the study of the two-phase flow structure. Over the next decade, it can be expected that mechanistic approaches will be more widely applied to the complicated two-phase fluid phenomena inside fuel bundles. The development of truly mechanistic models for critical power prediction is currently underway. These models must include elementary processes such as void distributions, droplet deposit, liquid film entrainment, etc. The BFBT benchmark consists of two parts (phases), each part consisting of different exercises: - Phase 1 Void Distribution Benchmark: Exercise 1: Steady-state sub-channel grade benchmark; Exercise 2: Steady-state microscopic grade benchmark; Exercise 3: Transient macroscopic grade benchmark. - Phase 2 Critical Power Benchmark: Exercise 1: Steady-state benchmark; Exercise 2: Transient benchmark. It should be recognized that the purpose of this benchmark is not only the comparison of currently available macroscopic approaches but above-all the
Abstract Background Diagrammatic recording of finger joint angles by using two criss-crossed paper strips can be a quick substitute to the standard goniometry. As a preliminary step toward clinical validation of the diagrammatic technique, the current study employed healthy subjects and non-professional raters to explore whether reliability estimates of the diagrammatic goniometry are comparable with those of the standard procedure. Methods The study included two procedurally different parts,...
Fitzgerald, J. W.
Camera system provides accurate photographic recording during acceleration of centrifuge and permits immediate observation of dynamic changes in retinal circulation by a closed-circuit television loop. System consists of main camera, remote control unit, and strobe power supply unit, and is used for fluorescein studies and dynamometry sequences.
A lot of statisticians, actuarial mathematicians, reliability engineers, meteorologists, hydrologists, economists. Business and sport analysts deal with records which play important roles in various fields of statistics and its application. This book enables a reader to check his/her level of understanding of the theory of record values. We give basic formulae which are more important in the theory and present a lot of examples which illustrate the theoretical statements. For a beginner in record statistics, as well as for graduate students the study of our book needs the basic knowledge of the subject. A more advanced reader can use our book to polish his/her knowledge. An upgraded list of bibliography which will help a reader to enrich his/her theoretical knowledge and widen the experience of dealing with ordered observations, is also given in the book.
Rong, X.; He, B.; Zhuang, L.
The existing interior decoration of Qing Dynasty is the master of that of each dynasty, with its diversified forms and complicated functions. As early as 1920s, the Rehabilitation Committee of Qing court recorded the interior furnishing in the Forbidden City by using Chinese traditional documentary method. Today, along with the constantly updated techniques, the recording method for the current situation of interior decoration has gradually developed from two-dimensional drawings into digital and comprehensive record. However, the current research results are mostly limited to a single field. This paper takes the digital record and reproduction about the current situation of interior decoration in Jingfu Palace in the Forbidden City as an example. Through the use of photogrammetry, 3D laser scanning, virtual display and other technology and equipment at the forefront of architectural field, it makes qualitative and quantitative record about the interior decoration inside Jingfu Palace. By combing with the interpretation of historical documents, it restores the original design ideas hidden behind the current situation of interior decoration, so as to summarize the best recording and reproducing method of interior decoration of Qing Dynasty.
Full Text Available The existing interior decoration of Qing Dynasty is the master of that of each dynasty, with its diversified forms and complicated functions. As early as 1920s, the Rehabilitation Committee of Qing court recorded the interior furnishing in the Forbidden City by using Chinese traditional documentary method. Today, along with the constantly updated techniques, the recording method for the current situation of interior decoration has gradually developed from two-dimensional drawings into digital and comprehensive record. However, the current research results are mostly limited to a single field. This paper takes the digital record and reproduction about the current situation of interior decoration in Jingfu Palace in the Forbidden City as an example. Through the use of photogrammetry, 3D laser scanning, virtual display and other technology and equipment at the forefront of architectural field, it makes qualitative and quantitative record about the interior decoration inside Jingfu Palace. By combing with the interpretation of historical documents, it restores the original design ideas hidden behind the current situation of interior decoration, so as to summarize the best recording and reproducing method of interior decoration of Qing Dynasty.
Winkelmann, I.; Kreiner, H.J.
This report describes newly developed methods of calibrating exhaust air measuring points. These methods have been tested in cooperation with the Bundesgesundheitsamt (Federal public health office) and Messrs. Kraftwerk Union. They have the advantage that calibration can be carried out during normal operation of the measuring points; their exactness is the same, if not higher than that of conventional methods, and they do not require much expenditure. This method of calibration has also been used for an assessment of the effectivity of different detector systems and measuring chambers. Furthermore, the report describes the installation and operation of a newly developed digital recording and balancing system for the activity emitted with the exhaust air in the stack of the FRN reactor. Using this system, the effective activity emitted with the exhaust air can be calculated, presented in a graph by a computer, and balanced, e.g. per year. (orig.) [de
Elfman, M.; Limburg, K.E.; Kristiansson, P.; Svedaeng, H.; Westin, L.; Wickstroem, H.; Malmqvist, K.; Pallon, J.
Diadromous fishes - species that move across salinity gradients as part of their life repertoire - form a major part of coastal and inland fisheries. Conventional mark-recapture techniques have long been used to track their movements, but give incomplete information at best. On the other hand, otoliths (ear-stones) of fishes can provide a complete record of major life history events, as reflected both in their microstructure and elemental composition. Strontium, which substitutes for calcium in the aragonite matrix of otoliths, is a powerful tracer of salinity histories in many migratory fishes. We measured Sr and Ca with a nuclear microprobe (PIXE) and show examples (eel, Anguilla anguilla; brown trout, Salmo trutta; American shad, Alosa sapidissima) of how the technique has solved several mysteries within fisheries biology
Birken, Catherine S; Tu, Karen; Oud, William; Carsley, Sarah; Hanna, Miranda; Lebovic, Gerald; Guttmann, Astrid
To determine the prevalence of overweight and obese status in children by age, sex, and visit type, using data from EMRALD ® (Electronic Medical Record Administrative data Linked Database). Heights and weights were abstracted for children 0 to 19 years of age who had at least one well-child visit from January 2010 to December 2011. Using the most recent visit, the proportions and 95% CIs of patients defined as overweight and obese were compared by age group, sex, and visit type using the World Health Organization growth reference standards. Ontario. Children 0 to 19 years of age who were rostered to a primary care physician participating in EMRALD and had at least one well-child visit from January 2010 to December 2011. Proportion and 95% CI of children with overweight and obese status by age group; proportion of children with overweight and obese status by sex (with male sex as the referent) within each age group; and proportion of children with overweight and obese status at the most recent well-child visit type compared with other visit types by age group. There were 28 083 well-child visits during this period. For children who attended well-child visits, 84.7% of visits had both a height and weight documented. Obesity rates were significantly higher in 1- to 4-year-olds compared with children younger than 1 (6.1% vs 2.3%; P overweight and obese status were lower using data from well-child visits compared with other visits. Electronic medical records might be useful to conduct population-based surveillance of overweight or obese status in children. Methodologic standards, however, should be developed. Copyright© the College of Family Physicians of Canada.
Chirico, G; Cabano, R; Villa, G; Bigogno, A; Ardesi, M; Dioni, E
Alleviating pain in neonates should be the goal of all caregivers. We evaluated whether recorded maternal voices were safe and effective in limiting pain in preterm infants undergoing heel lance procedures in the neonatal intensive care unit of an Italian children's hospital. This prospective, controlled study took place from December 2013 to December 2015. We enrolled 40 preterm infants, born at a 26-34 weeks of gestation, at a corrected gestational age 29-36 weeks and randomised them to listen or not listen to a recording of their mother's voice during a painful, routine heel lance for blood collection. Changes in the infants' Premature Infant Pain Profile, heart rate, oxygen saturation and blood pressure during the procedure were compared by analysis of variance. Possible side effects, of apnoea, bradycardia, seizures and vomiting, were also recorded. Both groups showed a marked increase in PIPP scores and decrease in oxygen saturation during the procedure, but infants in the treatment group had significantly lower PIPP scores (p = 0.00002) and lower decreases in oxygen saturation (p = 0.0283). No significant side effects were observed. Using recorded maternal voices to limit pain in preterm infants undergoing heel lance procedures appeared safe and effective. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Full Text Available Abstract Background The introduction of different interocclusal recording materials has put clinicians in dilemma that which material should be used in routine clinical practice for precise recording and transferring of accurate existing occlusal records for articulation of patient’s diagnostic or working casts in the fabrication of good satisfactory prosthesis. In the era of developing world of dentistry the different materials are introduced for interocclusal record with different brand names because of this; the utility of the material is confusing for successful delivery of prosthesis with lack of in vitro or in vivo studies which will predict the property of the material with utility recommendations. Purpose of the study The aim of this multicenter research is to evaluate the time dependent linear dimensional stability of three types of interocclusal recording materials; which gives very clear idea to clinicians in regard to its usage in routine practice and recommendations for usage of the different materials. Also to find out ideal time for articulation of three types of interocclusal recording materials with accuracy. Materials and method Commercially available and ADA approved Polyether bite registration paste (Ramitec, Poly vinyl siloxane bite registration paste (Jetbite and Zinc oxide eugenol (ZOE bite registration paste (Super bite were used in the study. A stainless steel die was made according to modified American dental Associations (ADA specification no. 19. Each one of the tested materials were manipulated according to manufacturers’ instructions. The materials separated from die, 3-mins after their respective setting time, resulted in disks of standard diameter. Two parallel lines and three perpendicular lines reproduced on the surface. The distance between two parallel lines was measured at different time intervals i.e. 1 hour, 24, 48 and 72 hours by using travelling microscope (magnus and compared with standard die
M. S. Abubakar
Full Text Available Farm records are mostly manually kept on paper notebooks and folders where similar records are organized in one folder or spread sheet. These records are usually kept for many years therefore they becomes bulky and less organized. Consequently, it becomes difficult to search, update and tedious and time consuming to manage these records. This study was carried-out to overcome these problems associated with manual farm records keeping by developing user-friendly, easily accessible, reliable and secured software. The software was limited records keeping in crop production, livestock production, poultry production, employees, income and expenditure. The system was implemented using Java Server Faces (JSF for designing Graphical User Interface (GUI, Enterprises Java Beans (EJB for logic tier and MySQL database for storing farm records.
de Lange, Gert J.; Versteegh, G.; Zonneveld, K.; Bernasconi, S.
Studies on high-resolution paleoclimate and with high-frequency variations, demand for continuous marine records with sufficient time resolution. Such records are rare but vital for our understanding of causes and consequences of climate and environmental change at decadal to millennial time scales. Our initial studies at a near-coastal and a deep Mediterranean anoxic basin site seem to provide a continuous marine paleo-climate record that permits such high-resolution and well dated climate reconstructions for at least the last few kyrs. Cores for the MOCCHA project have been collected during the pre-Moccha ESPRESSO cruise with RV Universitatis and CAPUCCINO cruise with RV Poseidon, followed by the DOPPIO cruise and the MACCHIATO-cruise with RV Pelagia. The cores recovered and studied thusfar appear to contain largely laminated sediments (submillimetric) down to 10 kyr. We will introduce the sites with existing and recently published evidence and supplement these with preliminary results for both sites obtained during these cruises. All of these are illustrating their suitability for high-resolution studies of paleoclimate that we hope to extend to > 35 kyr, i.e. for future IODP drilling. This work is supported by the EUROMARGINS Programme of the European Science Foundation NWO.817.01.002 MOCCHA project).
Tejo, Sampath Kumar; Kumar, Anil G; Kattimani, Vivekanand S; Desai, Priti D; Nalla, Sandeep; Chaitanya K, Krishna
The introduction of different interocclusal recording materials has put clinicians in dilemma that which material should be used in routine clinical practice for precise recording and transferring of accurate existing occlusal records for articulation of patient's diagnostic or working casts in the fabrication of good satisfactory prosthesis. In the era of developing world of dentistry the different materials are introduced for interocclusal record with different brand names because of this; the utility of the material is confusing for successful delivery of prosthesis with lack of in vitro or in vivo studies which will predict the property of the material with utility recommendations. The aim of this multicenter research is to evaluate the time dependent linear dimensional stability of three types of interocclusal recording materials; which gives very clear idea to clinicians in regard to its usage in routine practice and recommendations for usage of the different materials. Also to find out ideal time for articulation of three types of interocclusal recording materials with accuracy. Commercially available and ADA approved Polyether bite registration paste (Ramitec), Poly vinyl siloxane bite registration paste (Jetbite) and Zinc oxide eugenol (ZOE) bite registration paste (Super bite) were used in the study.A stainless steel die was made according to modified American dental Associations (ADA) specification no. 19. Each one of the tested materials were manipulated according to manufacturers' instructions. The materials separated from die, 3-mins after their respective setting time, resulted in disks of standard diameter. Two parallel lines and three perpendicular lines reproduced on the surface. The distance between two parallel lines was measured at different time intervals i.e. 1 hour, 24, 48 and 72 hours by using travelling microscope (magnus) and compared with standard die measurements made according to ADA specification no.19 to find out the dimensional
Alan Kevin Bourke
Full Text Available Physical activity monitoring algorithms are often developed using conditions that do not represent real-life activities, not developed using the target population, or not labelled to a high enough resolution to capture the true detail of human movement. We have designed a semi-structured supervised laboratory-based activity protocol and an unsupervised free-living activity protocol and recorded 20 older adults performing both protocols while wearing up to 12 body-worn sensors. Subjects’ movements were recorded using synchronised cameras (≥25 fps, both deployed in a laboratory environment to capture the in-lab portion of the protocol and a body-worn camera for out-of-lab activities. Video labelling of the subjects’ movements was performed by five raters using 11 different category labels. The overall level of agreement was high (percentage of agreement >90.05%, and Cohen’s Kappa, corrected kappa, Krippendorff’s alpha and Fleiss’ kappa >0.86. A total of 43.92 h of activities were recorded, including 9.52 h of in-lab and 34.41 h of out-of-lab activities. A total of 88.37% and 152.01% of planned transitions were recorded during the in-lab and out-of-lab scenarios, respectively. This study has produced the most detailed dataset to date of inertial sensor data, synchronised with high frame-rate (≥25 fps video labelled data recorded in a free-living environment from older adults living independently. This dataset is suitable for validation of existing activity classification systems and development of new activity classification algorithms.
Pinna, G D; Opasich, C; Massimo, S; Perinati, L; Cobelli, F; Tavazzi, L
The identification of reliable clinical and functional indicators of Chronic Heart Failure (CHF) is currently a major research challenge for physicians dealing with this pathology. With the aim of providing an adequate infrastructure for this research, we have developed a Database System where all relevant information concerning CHF patients during follow-up can be efficiently recorded, monitored, extracted and easily transferred to commercial packages for data processing and statistical analysis. Patient clinical status is recorded every 6 months, whereas data from several laboratory investigations are recorded every 12 months. All complications or events between two successive controls are recorded too. Patients needing cardiac transplantation are entered in a transplantation waiting list. The Database is fully integrated into the Hospital Information System and meets the standards of the national database of CHF patients. It grows with the concurrent activity of several independent teams, all of which have access to complete and structured information for research purposes. A user-friendly procedure allows the export in a standard format (Microsoft Excel) of all patients' data pertaining to a selected set of controls and variables of interest. These data are used directly for analysis or sub-selections are performed by the investigator through a simple query language. Depending on the objectives and complexity of the research, different commercial statistical analysis packages are available, which are used by clinical investigators autonomously or with the aid of a statistician. This overall approach allows great autonomy of each user in extracting, manipulating and statistically analyzing data. The Database has been in use at the Heart Failure Unit of our Rehabilitation Center since October 1992 and 595 patients have been enrolled since then. Several studies based on these data have been performed and more than 120 scientific communications and 30 articles in
Pierre-Cédric B. Crouch
two groups differed by race and computer access. There was no difference in the current CD4, provider satisfaction, Health Care Empowerment Inventory score, satisfaction with provider-patient communication, satisfaction with courteous and helpful staff, knowledge of ART, or ART adherence. The use of electronic personal health records is associated with positive clinical and behavioral characteristics. The use of these systems may play a role in improving the health of people with HIV. Larger studies are needed to further evaluate these associations.
Hayward, James; Thomson, Fionagh; Milne, Heather; Buckingham, Susan; Sheikh, Aziz; Fernando, Bernard; Cresswell, Kathrin; Williams, Robin; Pinnock, Hilary
Computerized decision support systems (CDSS) are commonly deployed to support prescribing, although over-riding of alerts by prescribers remains a concern. We aimed to understand how general practitioners (GPs) interact with prescribing CDSS in order to inform deliberation on how better to support prescribing decisions in primary care. Quantitative and qualitative analysis of interactions between GPs, patients, and computer systems using multi-channel video recordings of 112 primary care consultations with eight GPs in three UK practices. 132 prescriptions were issued in the course of 73 of the consultations, of which 81 (61%) attracted at least one alert. Of the total of 117 alerts, only three resulted in the GP checking, but not altering, the prescription. CDSS provided information and safety alerts at the point of generating a prescription. This was 'too much, too late' as the majority of the 'work' of prescribing occurred prior to using the computer. By the time an alert appeared, the GP had formulated the problem(s), potentially spent several minutes considering, explaining, negotiating, and reaching agreement with the patient about the proposed treatment, and had possibly given instructions and printed an information leaflet. CDSS alerts do not coincide with the prescribing workflow throughout the whole GP consultation. Current systems interrupt to correct decisions that have already been taken, rather than assisting formulation of the management plan. CDSS are likely to be more acceptable an